The American Medical Association, alongside MedStar Health's National Center for Human Factors in Healthcare, has launched a new framework to rank electronic health records according to their user-centered design, of UCD.

The aim, according to AMA and MedStar, is to spotlight the importance of UCD -- something officials call "an essential component in improving patient safety and the satisfaction of physicians, patients and medical professionals who use EHRs."

Too many vendors - even those certified by the Office of the National Coordinator for Health IT - still don't feature best UCD practices, they point out. Vendors must only report on the UCD processes they followed for the eight capabilities deemed critical to patient safety by ONC, which doesn't use UCD best practices as a basis for certification. 

[Related: How does your EHR stack up? See our 2015 satisfaction survey results.]

"We believe that EHRs should be designed with the end user in mind and the ONC's requirements do not go far enough to encourage fully functional and usable products," researchers write. "This framework can be used by the ONC to improve their certification program and as a method to track improvements EHR vendors make as they recertify their products over time."

The framework rates EHR products according to a 15-point scale of UCD best practices (rather than the actual usability of the EHR as experienced by end users). Using testing reports from ONCs' Certified Health Product List, AMA and MedStar analyzed 20 common EHRs, five inpatient and 15 ambulatory.

The top five EHR usability scores, according to the framework:

• Allscripts Enterprise EHR v11.4.1 (Score: 15)
• Allscripts Sunrise Acute v15.1-c INPATIENT (Score: 15)
• McKesson Specialty Health Paragon 12&2.0 INPATIENT (Score: 15)
• McKesson iKnowMedEHR v6.7 (Score: 14.5)
• athenahealth Athena Clinicals v14.9 (Score: 13.5)

The bottom five EHR usability scores:

• Nextgen Healthcare Ambulatory 5.8.2 (Score: 9.5)
• Epic Systems EpiCare Ambulatory 2014 (Epic2012) (Score: 9)
• Dr Systems eHR MU v2.0 (Score: 7)
• Greenway PrimeSUITE 2014(17.0) (Score: 7)

• eClinicalWorks Version 10 (Score: 5)

See the full ratings and read about the ranking methodology here.

"It is important to recognize this framework evaluates conformity with best practices identified in human factors and usability literature for user-centered design and testing," said Raj Ratwani, scientific director of the Human Factors Center and a principle developer of the framework, in a press statement.

"We are not evaluating the actual usability of the product as experienced by end users," he added. "Alignment with best practices for user-centered design and testing is a starting point that regulators and industry should meet and exceed. The framework we developed is the first step in bringing greater transparency to the usability processes of EHR vendors."

"Physician experiences documented by the AMA demonstrate that most EHR systems fail to support effective and efficient clinical work, and continued issues with usability are a key factor driving low satisfaction with many EHR products," said AMA President Steven J. Stack, MD, in a statement. "Our goal is to shine light on the low-bar of the certification process and how EHRs are designed and user-tested in order to drive improvements that respond to the urgent physician need for better designed EHR systems."

See also:

Object of beauty, or ungainly nuisance?
Senate panel to look into EHR usability
When EHR design is a 'what not to do'
Q&A: HxD conference co-founder Amy Cueva talks user-centered design
What will EHRs look like in 2020?