Download PDF
CC BY 4.0 · Appl Clin Inform 2023; 14(03): 494-502
DOI: 10.1055/a-2074-1665
Research Article

Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records

Brian Lefchak
1   NewYork-Presbyterian Hospital, New York, New York, United States
2   Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
,
Susan Bostwick
2   Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
,
Sarah Rossetti
3   Department of Biomedical Informatics, Columbia University, New York, New York, United States
4   Columbia University School of Nursing, New York, New York, United States
,
Kenneth Shen
1   NewYork-Presbyterian Hospital, New York, New York, United States
2   Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
,
Jessica Ancker
5   Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
,
Kenrick Cato
4   Columbia University School of Nursing, New York, New York, United States
,
Erika L. Abramson
2   Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
5   Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
,
Charlene Thomas
5   Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
,
Linda Gerber
5   Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
,
Amanda Moy
3   Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
Mohit Sharma
5   Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
,
Jonathan Elias
1   NewYork-Presbyterian Hospital, New York, New York, United States
5   Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background A growing body of literature has linked usability limitations within electronic health records (EHRs) to adverse outcomes which may in turn affect EHR system transitions. NewYork-Presbyterian Hospital, Columbia University College of Physicians and Surgeons (CU), and Weill Cornell Medical College (WC) are a tripartite organization with large academic medical centers that initiated a phased transition of their EHRs to one system, EpicCare.

Objectives This article characterizes usability perceptions stratified by provider roles by surveying WC ambulatory clinical staff already utilizing EpicCare and CU ambulatory clinical staff utilizing iterations of Allscripts before the implementation of EpicCare campus-wide.

Methods A customized 19-question electronic survey utilizing usability constructs based on the Health Information Technology Usability Evaluation Scale was anonymously administered prior to EHR transition. Responses were recorded with self-reported demographics.

Results A total of 1,666 CU and 1,065 WC staff with ambulatory self-identified work setting were chosen. Select demographic statistics between campus staff were generally similar with small differences in patterns of clinical and EHR experience. Results demonstrated significant differences in EHR usability perceptions among ambulatory staff based on role and EHR system. WC staff utilizing EpicCare accounted for more favorable usability metrics than CU across all constructs. Ordering providers (OPs) denoted less usability than non-OPs. The Perceived Usefulness and User Control constructs accounted for the largest differences in usability perceptions. The Cognitive Support and Situational Awareness construct was similarly low for both campuses. Prior EHR experience demonstrated limited associations.

Conclusion Usability perceptions can be affected by role and EHR system. OPs consistently denoted less usability overall and were more affected by EHR system than non-OPs. While there was greater perceived usability for EpicCare to perform tasks related to care coordination, documentation, and error prevention, there were persistent shortcomings regarding tab navigation and cognitive burden reduction, which have implications on provider efficiency and wellness.

Keywords

electronic health records - user-centered design - medical informatics applications - job satisfaction

Protection of Human and Animal Subjects

There was minimal risk from study participants and all aspects were approved by the Columbia University College of Physicians and Surgeons and Weill Cornell Medical College Institutional Review Boards.


Supplementary Material



Publication History

Received: 05 January 2023

Accepted: 19 March 2023

Accepted Manuscript online:
14 April 2023

Article published online:
28 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Menachemi N, Collum TH. Benefits and drawbacks of electronic health record systems. Risk Manag Healthc Policy 2011; 4: 47-55
    CrossrefPubMedGoogle Scholar
  • 2 Babbott S, Manwell LB, Brown R. et al. Electronic medical records and physician stress in primary care: results from the MEMO Study. J Am Med Inform Assoc 2014; 21 (e1): e100-e106
    CrossrefPubMedGoogle Scholar
  • 3 Howe JL, Adams KT, Hettinger AZ, Ratwani RM. Electronic health record usability issues and potential contribution to patient harm. JAMA 2018; 319 (12) 1276-1278
    CrossrefPubMedGoogle Scholar
  • 4 Elias J, Moy A, Lucas A. et al. Assessing Clinical Staff Usability & Satisfaction with Documentation & Information Retrieval Prior to an Electronic Health Record Implementation. Vol. 2019, AMIA … Annual Symposium proceedings / AMIA Symposium. AMIA Symposium; 2019
    PubMed
  • 5 Karsh BT, Weinger MB, Abbott PA, Wears RL. Health information technology: fallacies and sober realities. J Am Med Inform Assoc 2010; 17 (06) 617-623
    CrossrefPubMedGoogle Scholar
  • 6 Ratwani R, Fairbanks T, Savage E. et al. Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation. Appl Clin Inform 2016; 7 (04) 1069-1087
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Nielsen J. Usability Engineering. Boston, MA: Academic Press; 1993
    CrossrefGoogle Scholar
  • 8 Yen PY, Sousa KH, Bakken S. Examining construct and predictive validity of the Health-IT Usability Evaluation Scale: confirmatory factor analysis and structural equation modeling results. J Am Med Inform Assoc 2014; 21 (e2): e241-e248
    CrossrefPubMedGoogle Scholar
  • 9 Yen PY, Wantland D, Bakken S. Development of a customizable health IT usability evaluation scale. AMIA Annu Symp Proc 2010; 2010: 917-921
    PubMedGoogle Scholar
  • 10 Cheriff AD, Kapur AG, Qiu M, Cole CL. Physician productivity and the ambulatory EHR in a large academic multi-specialty physician group. Int J Med Inform 2010; 79 (07) 492-500
    CrossrefPubMedGoogle Scholar
  • 11 Wang SJ, Middleton B, Prosser LA. et al. A cost-benefit analysis of electronic medical records in primary care. Am J Med 2003; 114 (05) 397-403
    CrossrefPubMedGoogle Scholar
  • 12 Bishop TF, Ryan MS, McCullough CM, Shih SC, Casalino LP, Ryan AM. Do provider attitudes about electronic health records predict future electronic health record use?. Healthc (Amst) 2015; 3 (01) 5-11
    CrossrefPubMedGoogle Scholar
  • 13 Li RC, Wang JK, Sharp C, Chen JH. When order sets do not align with clinician workflow: assessing practice patterns in the electronic health record. BMJ Qual Saf 2019; 28 (12) 987-996
    PubMedGoogle Scholar
  • 14 Schnaus MJ, Michalik M, Skarda P. Effects of electronic medical record display on provider ordering behavior: leveraging the EMR to improve quality and costs. Am J Med 2017; 130 (12) 1366-1371
    CrossrefPubMedGoogle Scholar
  • 15 Gomes KM, Ratwani RM. Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability. JAMA Netw Open 2019; 2 (12) e1916651
    CrossrefPubMedGoogle Scholar
  • 16 Ratwani RM, Hodgkins M, Bates DW. Improving electronic health record usability and safety requires transparency. JAMA 2018; 320 (24) 2533-2534
    CrossrefPubMedGoogle Scholar
  • 17 Ratwani RM, Savage E, Will A. et al. Identifying electronic health record usability and safety challenges in pediatric settings. Health Aff (Millwood) 2018; 37 (11) 1752-1759
    CrossrefPubMedGoogle Scholar
  • 18 Muthu N, Ratwani RM. Catalyzing pediatric electronic health record usability and safety improvements. Pediatrics 2020; 146 (06) 1-3
    CrossrefPubMedGoogle Scholar
  • 19 Khajouei R, Jaspers MW. The impact of CPOE medication systems' design aspects on usability, workflow and medication orders: a systematic review. Methods Inf Med 2010; 49 (01) 3-19
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Kutney-Lee A, Brooks Carthon M, Sloane DM, Bowles KH, McHugh MD, Aiken LH. Electronic health record usability: associations with nurse and patient outcomes in hospitals. Med Care 2021; 59 (07) 625-631
    CrossrefPubMedGoogle Scholar
  • 21 Simpson JR, Lin CT, Sieja A, Sillau SH, Pell J. Optimizing the electronic health record: an inpatient sprint addresses provider burnout and improves electronic health record satisfaction. J Am Med Inform Assoc 2021; 28 (03) 628-631
    CrossrefPubMedGoogle Scholar
  • 22 Koppel R, Lehmann CU. Implications of an emerging EHR monoculture for hospitals and healthcare systems. J Am Med Inform Assoc 2015; 22 (02) 465-471
    CrossrefPubMedGoogle Scholar
  • 23 Huang C, Koppel R, McGreevey III JD, Craven CK, Schreiber R. Transitions from one electronic health record to another: challenges, pitfalls, and recommendations. Appl Clin Inform 2020; 11 (05) 742-754
    Article in Thieme ConnectPubMedGoogle Scholar