Electronic Health Record Usability Evaluation Improves Training (Preprint)

BACKGROUND EHRs are said to reduce physician workload, however, physicians who are not appropriately trained on using an EHR in medical school may encounter a steep learning curve and experience usability issues when using the EHR in clinical practice Usability is important because it is one of the major factors hindering the widespread adoption of EHRs. Usability evaluation can play an important role in improving EHR usability and training. OBJECTIVE To determine usability issues experienced by expert and novice primary care physicians when using an electronic health record (EHR) to improve the EHR training program for new physicians. METHODS Family and Community Medicine, four Internal Medicine residents volunteered to participate and were compensated for their involvement in the project. Two rounds of usability tests were conducted using video to analyze usability issues. Physicians completed nineteen tasks, using think aloud strategy, based on an artificial but typical patient visit note. Thematic analysis was employed to analyze usability issues. RESULTS Novices and expert resident physicians experienced significantly less usability issues in round two than in round one. There was a statistically significant difference (w-value=18, P<0.05) between the number of novices experiencing usability issues in round one than the number of novices experiencing usability issues in round two. There was a statistically significant difference (w-value=5, P<0.05) between the number of experts experiencing usability issues in round one than in round two (Table 5). Thirty-five usability issues were identified across two rounds. Five themes emerged during analysis: inconsistencies (6 issues), user interface (9 issues), structured data (6 issues), ambiguous terminology (7 issues), and workarounds (6 issues). CONCLUSIONS This study was able to identify varying degrees of usability issues experienced by expert and novice physicians that may be impeding the use of EHRs. These results highlight the areas of difficulty resident physicians with different experience levels are currently facing, which may improve the EHR training program and increase physicians’ performance when using an EHR.