Where Are Usability Standards For EMRs?

The other day, I was talking with a physician about ambulatory EMRs.  “None of them are any good,” said the doctor, who’s studied EMRs for several years but never invested in one. “I can’t find a single one that I can use.”

Are any of you surprised to hear him say that? I’m certainly not.  Perhaps he’s exaggerating a bit when he says that absolutely none are usable at all, but it’s hard to argue that doctors cope with a counter intuitive mess far too often.  And of course, enterprise EMRs get if anything lower usability ratings from practicing doctors.

All of which brings me around to the notion of EMR usability standards, or rather, the lack of such same. While those in the industry talk often about usability, there’s no real consensus standard for measuring how usable a particular EMR is, despite noble efforts by NIST and impassioned advocacy by usability gurus in the field.

Certainly, private research organizations take usability into account when they survey clinicians on which EMRs they prefer. So clunky EMRs with lousy UIs do pay some kind of price when they’re rated by the clinical user. But that’s a far cry from having a standard in place by which medical practices and hospitals can objectively consider how usable their preferred EMR is going to be.

So, why don’t we have usability standards already in place?  The market still hasn’t punished vendors whose EMRs are a pain to use, so vendors keep on turning our products built around IT rather than clinical needs. The doctor I spoke with may have opted out of the EMR market, but most providers aren’t going to do that, Meaningful Use incentives being just one reason why. (It’s a “handwriting is on the wall” thing.)

It’s a shame CMS isn’t pushing vendors to produce Meaningfully Use-ABLE EMRs. That might do the trick.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • I agree with Anne Zieger. We desperately need EMR usability standards in the healthcare industry. Usability has got nothing to do with tech-savviness. Usability is related to Human-Computer Interaction where the social and cognitive characteristics of people who use systems is studied so that techniques for understanding user needs, interface prototyping, and interface evaluation could be developed.

    Given that in some organizations, physician productivity is measured and based on the number of patients seen, it is not uncommon for clinicians to lose productivity during training days as they try to adapt to new tools (tablets) and workflows. Here are a few principles, which I think would make a drastic difference in the way EMR systems are used today.

    * EMR systems should have a consistent hierarchy for navigation so
    that it is easy for users to locate information.
    * Error messages should be clear. They should explain why the error
    occurred and explain what the users should do next. Definitely not
    any programming language errors.
    * For screens that contain too much information, there should be an
    option available for the users either to see the summary or a
    detailed drill-down capability. Some EMR vendors have started
    incorporating this functionality into their reporting modules.
    * Consistency should be followed in displaying allergies and current
    medications in one single location. Users should not have to click
    multiple windows to get to this. This also applies to past
    encounters(progress notes) which have been migrated prior to
    implementation of the new EMR system.
    * It would also be interesting to see if EMR vendors could incorporate
    the cultural context and meaning of a color in that context before
    they use the entire color palette in their software.

  • Very interesting article. I wonder if those individuals assigned to the assessment process would be battling/answering:

    Is this system easier to use than XYZ EMR?
    Are trainers on this project training efficiently?
    Were sufficient builders/analysts on this project?
    Are clinicians more or less motivated to adapt to the EMR at this organization opposed to others?

    Fascinating to think about. Great read Anne!

  • By the time the standards are written, their technology assumptions will be out of date. How do you apply PC-desktop usability standards to speech recognition or google glasses?

  • The problem is not the standards. The problem is a business model where doctors don’t actually choose their software tools because the database and the interface (the usability) are purchased from the same vendor as a monolithic system. Vendor lock-in works much better for the vendors than it does for the professionals who face incredibly high switching costs and are unable to choose the tools that each prefers.

    Adding standards and regulations is not a stable strategy for a high-tech field that should be moving at the speed of Moore’s law and social media. Patient-centered systems, by definition, are not tied to any one institution’s vendor or interface. It’s time to shift our attention to projects such as SMArt and Indivo and RHEx and ABBI where interfaces and usability are not tied to a single vendor.

  • Dr. Gropper makes an interesting point: usability will improve as interoperability improves. If the problem is that monolith vendors lack departmental-specific workflow tools (and I think that is the problem), then a return to best-of-breed will naturally mean a return to usability. But interoperability has to come first.

  • I agree with Dr. Gropper that doctors don’t get to choose their software.
    Then again, I’ve seen so many instances where physician adoption has lagged specifically after a change in interface. ‘Inertia to change’ has slowed us down several times, when we were trying to improve readability, design and usability of some provider tools.

Click here to post a comment