User-Centered Design Key to EHR Usability for Primary Care Docs

It may be easier consumers to find their perfect pair of sneakers online than it is for primary care providers to access the data necessary for clinical decision support, according to Regenstrief Institute researchers. A new study revealed that PCPs experience EHR usability challenges, signaling the need for user-centered design.

The study, published in the Human Factors and Ergonomics Society’s journal Human Factors, reviewed and analyzed research about PCP EHR use conducted from 2012 through 2020.

Regenstrief and IUPUI researchers found that study designs were mostly noninterventional; studies described problems related to EHR usability, workflow, and communication. PCPs often described EHR data as incomplete, untimely, or irrelevant.

The researchers mapped their review’s findings onto a three-level framework to measure PCP situation awareness (SA), which refers to a provider’s understanding of her environment. Level one indicates basic perception, two indicates comprehension, and three signals projection.

“In primary care, reduced SA among physicians increases errors in clinical decision-making and, correspondingly, patients’ risk of experiencing adverse outcomes,” the study authors noted.

According to the findings, PCPs did not have access to the necessary data to achieve level one SA.

"The human mind can do many things well,” April Savoy, PhD, human factors engineer, Regenstrief Institute research scientist, and lead author of the study, said in a press release. “Digesting vast amounts of patient information while multitasking in time-constrained situations exposes a limitation. EHR technology should be able to complement or enhance physicians' abilities in these scenarios.”

"Current EHRs are overloading primary care physicians with information in disparate files and folders rather than presenting comprehensive, actionable data in a context that gives meaning,” Savoy explained.

Sorting through multiple systems and tabs to access clinical information is inefficient and may lead to greater clinician burden.

Savoy noted that it can be easier for consumers to find a pair of shoes in a desired size, color, and style online than it is for PCPs to order a specialty consultation or medication refill.

While EHRs have been tailored for specialists, operating rooms, and hospitals, there has been a lack of attention to the needs of PCPs whose decision-making is based on the perception and comprehension of a patient's dynamic health and wellness situation, Savoy explained.

Access to a patient’s full health record provides PCPs with clinical decision support. For instance, when considering deprescribing a medication, a provider can analyze trends of patient's blood pressure or cholesterol levels over the previous month to help confirm that they are making the right decision for the individual patient, Savoy noted.

Not only did the review find that PCPs struggle with the completeness of EHR data; there are also issues regarding basic EHR features. Many systems lack basic features such as “auto-save,” which are common in online shopping, Savoy said.

The authors noted that to improve EHR usability for PCPs, future EHR design and evaluation should incorporate user-centered design principles.

"Technology needs to adapt to humans' needs, abilities, and limitations in healthcare delivery as it has in other domains,” Savoy said. “You can get the most advanced technology available – the fastest car, the smartest cell phone – but if it is not useful or if usability fails, users should not be forced to change their approach or work. The technology should be redesigned.”

“Similarly, EHRs should be redesigned to improve situation awareness for busy primary care physicians and support their tasks including reviewing patient information, care coordination, and shared decision-making,” she continued.

The Human Factors Engineering Directorate in the Department of Veterans Affairs’ Office of Health Informatics funded the study.