Electronic health records (EHRs) have to be usable and useful by physicians and integrate with hospitals’ or practices’ other systems to benefit providers or else the money spent on them is just wasted.

Before EHRs were widely adopted, there wasn’t a demand for usability, according to David Blumenthal, MD, former national health IT coordinator and current president and CEO of The Commonwealth Fund.

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“There was no reason for vendors to focus on it because there weren’t enough sales or selectivity on the part of purchasers,” he said at the AcademyHealth-sponsored National Health Policy Conference last week. But times have changed.

Certification of EHRs for meaningful use and the natural course of disruptive technologies will breed more usable EHRs and other health IT tools for physicians. Changes are already on the way.

Usability often focuses on patient safety issues of the system and adequate training of the physician, said experts speaking at the Feb. 4 gathering, but usability needs to go beyond that.

The permanent certification program developed by the Office of the National Coordinator for Health IT, similar to the inspection sticker for a car, has defined the required functionality of EHRs, said Jacob Reider, MD, a practicing physician and director of ONC’s Office of the Chief Medical Officer.

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But vendors must also use consumer-aided usability design processes, he said, and best practices for manufacturing products.

“We want EHRs to be functional, reliable, convenient and meaningful,” he said.

The National Institute of Standards and Technology (NIST) is developing a framework to think about the use of EHRs in relation to adverse events and patient safety. Lana Lowry, NIST project lead on usability and human factors for health IT, believes that in addition to a set of technical requirements for functionality, systems need to have the same set of user requirements for how a user performs with the system.

"We need to start testing on representative sets of users, not just one type of physician using it," commented Chris Gibbons, MD, associate director of Johns Hopkins Urban Health Institute. Gibbons has worked with NIST on usability framework activities.

In thinking about making EHRs more usable, something else to keep in mind are the differences between large and small providers.

Large providers are not surprised that EHRs take a lot of time, money and professional services, said Anita Samarth, technical assistance director for Washington, D.C.’s health IT extension center, eHealthDC-DCPCA, but smaller providers have a tougher time. 

For the small provider, “their perspective of usability is ‘can I use it and can I get through this visit fast enough?’” she said.

“We need to look at usability from the provider end user, depending on their size, provider demographic and practice population demographic,” she said, adding that different kinds of specialists will need different capabilities for their EHRs.

Like in other industries outside healthcare, concluded Jacob Reider, disruptive innovations on the electronic health record front will evolve as the healthcare industry becomes more digitized. “Some vendors are starting to use the same kinds of usability techniques that Google, Yahoo and other innovative companies have used,” he said, “and are doing it with audiovisual testing on live users."