Usability: A Necessary Prerequisite to Meaningful Use

Physicians must actually use certified EHRs to satisfy meaningful use criteria in order to be eligible for incentive payments under the American Recovery and Reinvestment Act. But this is easier said than done as many of the systems remain difficult to handle for physicians.

As a result, the American Medical Association and other organizations have called for a system certification program that would take usability concerns into account. The current stamp of approval – provided through the Office of the National Coordinator for Health Information Technology – offers assurance on functionality such as computerized physician order entry, data storage and confidentiality but does not assess usability.

“We continue to harbor significant concerns over EHR usability issues,” wrote James L. Madara, M.D., AMA executive vice president and CEO, in comments to proposed regulations from the federal government.

Including usability standards in the certification process would help ensure that physicians purchase products that will work best for them over the long run, the AMA said.

Upping the usability quotient also could help improve patient safety efforts, according to the Institute of Medicine's November 2011 report, "Health IT and Patient Safety: Building Safer Systems for Better Care." The report cited lack of usability as one potential cause of errors in using EHRs.

“Software - such as an EHR - is neither safe nor unsafe because safety of health IT cannot exist in isolation from its context of use. Safety is an emergent property of a larger system that takes into account not just the software but also how it is used by clinicians," the report states.

As a result, if the system is not being optimally used, safety is likely to be compromised.

"Poor interface design that detracts from clinician efficiency and affinity for the system will likely lead to underuse or misuse of the system," according to the IOM report.

The AMA recommended that HHS hold a survey on EHR satisfaction. Results would be disseminated and incorporated into future certification of the technology.