Electronic health record vendors are not adhering to usability testing standards for their EHR products and are failing to meet federally mandated user-centered design requirements, despite the EHRs being certified by the Office of the National Coordinator for Health IT for meeting requirements of the Meaningful Use program.

That’s the conclusion of Raj Ratwani, Ph.D., ‎scientific director of MedStar Health’s National Center for Human Factors in Healthcare, and his colleagues who studied publicly available reports from the top 50 EHR vendors, as measured by the number of Meaningful Use attestations they had made between April 1, 2013, and Nov. 30, 2014. Their research, published on Tuesday in the Journal of the American Medical Association, focused specifically on the 2014 Certification Edition requirements.

“What we looked at is the certification process and whether vendors are adhering to that process,” says Ratwani. “What we found is that roughly a third of the vendors that we analyzed didn’t actually have a user-centered design (UCD) process in place or certainly didn’t attest to one as the certification requirements require.”

Among other findings:

*63 percent of the vendors whose reported results were analyzed failed to enroll the recommended number of users—at least 15—in tests on their EHRs.

*17 percent used no physician participants in usability testing of systems intended for physician use.

*12 percent of vendor reports lacked enough detail to determine whether physicians participated.

According to Ratwani, this lack of adherence to usability testing standards among EHR products certified as having met these requirements may be a major factor contributing to the poor usability of EHRs and physician dissatisfaction.

Also See: Surveys on Physician EHR Satisfaction Show Conflicting Results

“I think this begins to shed some light on some of the challenges around EHR usability,” says Ratwani, who also argues that—in addition to creating “tremendous frustration” among clinicians—poor usability poses significant patient safety risks.

As he explains, “the reason the ONC requires EHR vendor products to be certified as having followed UCD processes—an approach that puts the cognitive workflow and information needs of the clinical user at the forefront of design and development—is to ensure EHRs support clinical staff as they perform their work and reduce the potential for error and patient harm.”          

The National Center for Human Factors in Healthcare conducts safety science and applied research in medicine to improve safety, quality, efficiency, and reliability. MedStar Health is the largest not-for-profit provider in the Maryland and Washington, D.C., area, with 10 hospitals and an extensive ambulatory services network, and is the medical education and clinical partner of Georgetown University.  

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