Nurses Give EHR Usability a Failing Grade, Report Burnout

Aligned with their physician counterparts, nurses graded EHR usability an “F,” and respondents also revealed a high level of burnout, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

Clinician burnout is commonly associated with the usability, emergence, and prevalence of EHRs. Poor EHR usability leads to high levels of physician attrition, depression, dissatisfaction, and burnout.

On the other hand, improved EHR usability can lead to higher EHR adoption rates, fewer clinical errors, less clinician burnout, financial benefits, and improved patient safety.

Although several studies have measured physician EHR usability perception, this is the first study to measure nurse EHR usability using a standardized metric.

Researchers surveyed 1,285 nurses from all practice settings who represented the American Nurse Association to assess nurse-perceived EHR usability and its association with clinician burnout.  

Researchers utilized the system usability scale (SUS) to gauge satisfaction. The system is based on a 100-point scale using respondent answers to a 10-question survey regarding EHR usability. The higher the score, the better the usability.

The nurse respondents revealed an average SUS score of 57.6, which would be equivalent to an “F” letter grade. Seventy-three percent of nurse respondents graded EHR usability below a 68, the average SUS score across all SUS-based studies.

Researchers also utilized a Maslach Burnout Inventory (MBI) EHR sub-survey to gauge nurse burnout. MBI is based on a seven-point Likert scale of frequency, ranging from “never” to “every day.”

Forty-two percent of nurse respondents revealed to be burnt out and experienced high emotional exhaustion and/or a high depersonalization MBI score.

What’s more, the data emphasized the link between EHR usability and clinician burnout. The study showed nurses with higher SUS scores, or higher perceived EHR usability, had lower emotional exhaustion scores, lower depersonalization scores, and lower overall rates of burnout.  

“For every point higher on the SUS scale, the odds of nurse burnout was 2% lower in a strong and independent dose-response relationship,” explained the study authors.

“The magnitude of this association is illustrated by the fact that the difference between the observed mean SUS score of 57.6 and the vendor-reported EHR usability for certification requirement score in 2015 of 75.0 would be associated with a 31% lower odds of burnout.”

The study authors said they leveraged SUS to provide a global assessment of nursing EHR usability across all practice settings and regardless of EHR vendor.

“Furthermore, by measuring usability with this industry standard metric, we can benchmark nursing EHR usability to technologies from other industries as well as physician EHR usability,” the study authors described.

For example, the average nurse SUS score was similar to a study that scored users on Microsoft Excel. It also revealed nurses report higher EHR satisfaction than their physician counterparts, who reported an average EHR usability score of 45.9.

“Nevertheless, the gap between both nurse and physician-rated EHR usability scores to those reported by EHR vendors suggests that these scores do indeed represent the current state of EHR usability and that this EHR usability reality gap also must be addressed so that nursing EHR tools better meet actual nursing needs,” the study authors explained.

Although nurses are typically more satisfied with the EHR than their physician counterparts, their needs differ and might be overlooked compared to physicians.

“We believe that real-world usability testing is an important next step for vendors to begin to close the EHR usability reality gap,” the researchers said.

EHR systems are constantly evolving. But while technology aims to help its users complete daily tasks, usability problems tend to arise. EHR usability problems can lead to patient safety issues and an increased burnout risk for its users.

“Nurse-perceived EHR usability and the odds of burnout were strongly associated with a dose-response relationship with nursing EHR usability behind many other everyday technologies,” concluded the study authors. “Improving EHR usability has the potential to improve patient safety and reduce nursing professional burnout.”