Usability: Can Every EHR Be Above Average?

Usability is the key differentiator between the long-term success and failure of an EHR implementation. The findings of the recent MGMA study lead to the inescapable and troubling conclusion that too many physicians do not consider their EHRs “usable.” A bad EHR choice is costly for the particular physician(s) and, while it might suffice in the short term for the purpose of earning meaningful use incentives, it will do nothing in the long run to foster sustained EHR adoption. Recognizing this, the HIT Policy Committee’s Adoption and Certification Workgroup convened an 8-hour hearing last week on the subject of how to define and measure usability. Recommendations were offered that mirrored my EHR reform proposal, and various groups/studies are already working on usability testing. One such group is CCHIT, which has introduced a usability rating tool into its commercial certification (not to be confused with government-certification) process. In her testimony, Karen Bell, M.D., Chair of CCHIT, discussed the results (Chart 1) and her recommendations.

So what’s wrong with this picture?

What’s wrong is that, to be useful to physicians, it has to look like this:

This is not meant as an indictment of CCHIT—the organization is to be commended for having taken an important first step in defining usability and creating a process for measuring it. The problem—which Karen Bell did acknowledge when challenged about it—is that if this rating scale were an accurate reflection of usability, there would be many fewer complaints about EHRs and, in my opinion, many fewer failures.

To provide physicians with the objective information that will be valuable to them in EHR purchase decisions, the ratings must be comparative and follow a normal distribution, as illustrated in Chart 2 above. Because achieving this distribution would require more aggressive usability criteria, it would distinguish those EHRs that have the greatest positive impact on productivity and cost savings from those that have a lesser, or negative, impact in these areas.

Even more important, this more challenging evaluation will create a market in which vendors are forced to compete on usability and how to better meet the needs of physicians. Physician satisfaction levels will increase. It will elevate quality across the board and raise the level of the entire EHR industry. Perhaps, as Dr. Ross Koppel testified at the Usability Hearing, if health IT were more usable, we wouldn’t even need incentives to spur EHR adoption!