12 0 obj These design directions are not necessarily specific to medical systems but are crucial to the success of future systems. Even with a customized user interface, there are individual differences within a specialty. endstream As well, a tablet interface will also be important for sketching pictures of eyes, hands, and other anatomic characteristics. 23 0 obj Use appropriate defaults to reduce non-productive work load. Rather than separately entering the chief complaint, ordering labs, prescribing meds, and typing notes, the interface can record defaults for labs, meds, and notes once the physician selects sore throat as the chief complaint. Each time a physician meets with a patient, the physician must record what happened in a note. In general, prevention-oriented family doctors saw the same user interface as orthopedists. You also experienced several administrative subtasks not related to medical care, i.e., filling out forms and paying for the visit, along with many minutes of reading old magazines, watching TV, and browsing colorful brochures on osteoporosis and circumcision. 2�Jr��bE������4��%ڨ+�f�:Mˆ�'� dQ��;eQ{K�Im_j �\tح4�_ܨ�6i�Qt�We?�����*�`�(����w纤�Xb�K��XKMe�$D���F� Bs[Y��ʢ_*Q%�_I����S|F�p|z)ɐ�+�����:�h��5W��Ay\R�޿й�d�R��̜���:��f�l_u��0T��;8cx��9�~Ho?� �N,2���ԛK�J�Wi,%�'���;bRb�֚�'���Z�=X�E� z*�S���2��*��l�S��F7�=2�2���w8��T�#�D�)� H}ϦϢ�sZi�.|u8%��k��T�ӥ�|�.�5/�DȈ.5��Rq�B�}��\����ȗ�r S�\�ܪ�OjⓚD����ӴlH;t���nft��n�Ya��{��ռ�&m�IK�ocD���P4�\N ����$цA�^F�j�pP��g�C�~;WƖ&'W����R�>,� N���KL3��� 70 0 obj �0E���ԅ���v+��n�&mGҤ�A�_oZW���a�b/�?���y�������2�K�p��V��< `�{�(meNb ��VH%��G�5Bc� Finally, some physicians prefer combinations, e.g., importing boilerplate data, like medications and labs, while typing in their plans. 48 0 obj In addition he is a Usability Coach, helping new and seasoned practitioners solve usability problems. There is certainly a complex relationship among EMR usage, quality of clinical care, and the implementation of nationalized medicine. endobj x�+� � | Share . (koͩ Hal is a Project Director with Human Factors International (HFI) and has been designing and evaluating user interfaces for over 30 years. Figure 5. Unfortunately, one system we observed requires that the nurses log into the EMR as themselves but order labs and procedures via proxy. This understanding of the tasks and task flows completed by physicians was essential to our analysis of EMR usability. Physicians speak one language, but the procedures and diagnoses are sometimes based on a different set of codes. Eisenberg, D. (2001, April 23). Once implemented, EMRs provide enormous benefits. In this paper we present the development and usability of an electronic health record (EHR) system in a comprehensive dental clinic.The graphic user interface of the system was designed to consider the concept of cognitive ergonomics.The cognitive task analysis was used to evaluate the user interface of the EHR by identifying all sub-tasks and classifying them into mental or physical operators, and to … �u�;B��T=e �55A/��U��ɞ= �L�;>�2r�#]�Ho��| ��@� However, a few prominent failures of medical systems are readily available, namely the physician rejection of the order entry system at Cedars Sinai and the struggles at Kaiser as they tried to implement an EMR system. <>stream endstream Those with strong typing skills will prefer to type when entering notes from patient visits. Getting data into the system can be done in different ways, and each provider has his or her preferences. endobj endstream Figure 4. Medical care can be a costly enterprise for any country. 14 0 obj The interrelations and dependencies with the human body are immense. Finally, to support physicians as they complete their tasks, they need a very complex but efficient information system. (January 20, 2004). Hospitals and clinics promise to be a fertile ground for data visualization software and for the manufacturers of display hardware. Time is not lost searching for the patient’s paper chart because all patient information is electronic. He or she looks at your throat, up your nose, and in your ears. endobj Little empirical research has examined sociotechnical factors, such as the work environment, … x�m�A While this approach sounds promising, the usability of the templates must be thoroughly user-tested to ensure that it meets the needs of both data entry and retrieval. Usability improvements in electronic health records (EHRs) are associated with improved cognitive workload and performance levels among clinicians, according to a study published in JAMA. endstream <> Time is also saved when looking through the patient’s chart electronically, a faster process than scanning reams of paper. 15 0 obj x�+� � | Some of the most commonly prescribed medications are Lipitor (cholesterol), Prevacid (acid reflux), Atenolol (beta blocker for high blood pressure), Prozac (antidepressant), and Zoloft (antidepressant). In addition, a usable EMR should allow the physician to inherit the login used by the nurse who took the vitals and recorded the patient’s chief complaint to reduce the initial login time. He previously started and led the UX group at Cargill. 56 0 obj Radiologists work with digitized images. <>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/ExtGState<>/Font<>/XObject<>>>/Parent 37 0 R/CropBox[0 0 613.266 811.688]/TrimBox[9 9 604.266 802.688]/MediaBox[0 0 613.247 811.672]>> 9005004. Information Technology Laboratory . And they often interact with each other and with peoples’ allergies. For example, the physician can order blood tests (labs), an MR scan (procedure), a prescription for penicillin (medications), a consultation with a specialist in ENT (consult), and a follow-up visit. In addition, physicians specialize in one of dozens of specialties. These stem from the complex interaction of highly skilled physicians trying to complete complex tasks in a challenging work environment with a complex and not always usable medical information system. ��s�w#b譣wr$�਎���tkIM�3���TSP2��'���w��W�?�˟ҫT���@� And physicians daily faced a flood of excessive electronic reminders, questions, and alerts with the new system. 21 0 obj We reflect on what went well in the past (and perhaps what didn’t go so well); we anticipate future challenges and accomplishments. Physicians vary in how they delegate responsibilities to nurses or assistants. x�+� � | <>stream State of the Union Address. There is of course a potential problem with the extensive use of defaults. Some screens contain information that is not needed, but missing information that is. ��N��u��,B�����Fu�A3x'�gt�ɫ1.���˪�5�q���x����q>���Q�m5�A��B�}�|vTuD�B]�8 ��������or�y7\�����Kκ��q ��;�kk��3:�·��q���q�dӿTi��$�Ns=�]�h��(��%⧤W����?�i����{�A�Y�'{ٍ' ����~8l�R!al��B����;��݁�'h Our observations on EMRs are based on visits to several IHS facilities with dozens of health care providers using a single EMR system that has been locally customized. As a result, the interface can dramatically simplify handling common problems, e.g., sore throat. This implies that they need an interface customized for their specialty. Then there are pain relievers, tranquilizers, allergy medicines, antibiotics, medicines for blood pressure, sleeping pills, and stomach remedies. A usability colleague of mine once said, “Ignore the differences between users. Usability was determined by measuring effectiveness, efficiency, and satisfaction. In essence, a system with good usability is easy to use and effective. endobj If someone has diabetes, there is not just one code to describe it but dozens. <>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/ExtGState<>/Font<>/XObject<>>>/Parent 37 0 R/CropBox[0 0 613.266 811.688]/TrimBox[9 9 604.266 802.688]/MediaBox[0 0 613.247 811.672]>> Searching for a procedure or diagnosis can produce useless results. Unfortunately, all the news is not good. There are also strong correlations between high rates of EMR use and key indicators of clinical care, including access to after-hours care, the use of clinical teams to manage chronically ill patients, and the ability to track medical errors. And those last two digits, .62, are required to describe an adult with diabetes on insulin who has nerve damage. Switching between patients then becomes a frequent but time-consuming process. Parallel work on one patient by both the physician and the nurse requires that the EMR allow simultaneous access to the same patient record, even though many database systems limit simultaneous access. 18 0 obj 24 0 obj endstream CIS was ultimately abandoned, and Kaiser is now implementing Epic’s EMR. �0E����ԅ���v+��n�&m#iR�ԯ7�+A�s�2sP��?T�����V�8��$�2�K@����4GQ��� 6� 땇�M� ��&�-R���t����5z�p7�|p��AY�tkIM�3Fg{U� E�eOBW��N�����H�?�k�"��@� The report recommends that health care providers and EHR developers use safety-based, rigorous test case scenarios that are outlined in the report to detect and correct problems and help avoid patient safety issues similar to those reported above. 40 0 obj Which pharmacy do you use?”. Usability represents an important yet often overlooked factor impacting the adoption and meaningful use of electronic health record (EHR) systems. If physicians enter data as free-form text, then subsequent physicians will struggle to search it for specific information, e.g., “When was this patient’s last mammogram?” The answer may be buried in one of dozens of separate notes. endstream endobj 4 0 obj Unfortunately, 30% of EMR system implementations fail, often because physicians cannot use the EMRs efficiently. 11-0084-EF August 2011 HEALTH IT . More specifically, clinicians were taking an extra 30 to 75 minutes per day to do their work, because there were too many steps to complete simple tasks, and the system was too cumbersome to adapt to the needs of the clinicians. There is even a Presidential initiative in the U.S. to speed the implementation of EMRs to “avoid dangerous medical mistakes, reduce costs, and improve care” (Bush, 2006). <>/Subtype/Link/Type/Annot/Border[0 0 0]/Rect[468.85 111.175 522.935 118.715]>> The delegation of work varies across physicians. Based upon our discussions and observations with the various medical personnel, we are proposing several design directions that future medical systems should consider. However, in family medicine, and often in internal medicine, they are more focused on prevention, particularly when seeing a patient for a regular check-up. Point and click interfaces are a vast improvement over the older text-based 3270 screens. To support research and policy formation in the area of Electronic Health Record (EHR) usability, the Agency for Healthcare Research and Quality (AHRQ) commissioned the “Use of Dense Display and Information Design Principles in Primary Care Health IT Systems” study. To quote Michael Dotti, M.D., of North Country Family Practice, “An EMR would enable us to keep better track of data. Nor can we dive into all the usability problems of EMRs. “This is a result of EMRs that have been over-engineered and are not intuitive, forcing physicians to spend more time clicking through screens and menus to get their work done” (Brown, 2005, p. 47). As more and more physicians become computer savvy, this problem may diminish. Implementing electronic medical records (EMR) systems are a popular solution to reducing costs, with the side benefit of providing better care. �0E����l�jA����Э��)1�y ���U)ùp�9�ɋ��`ɅF,q�I�8f��.�y^&� t";: According to Healthcare Information Management Systems Society (HIMSS) EHR Usability is defined as: “The effectiveness, efficiency and satisfaction with which specific users can achieve a specific set of tasks in a particular environment. EHR Usability Toolkit: A … 17 0 obj Physicians who treat multiple patients at any one time by using several exam rooms are often penalized by EMR systems that require them to log out when leaving one room and log in when entering another. However, the usability of EHRs, defined as the extent to which this technology can be used efficiently, effectively, and satisfactorily, continues to frustrate physicians. On the way out the door, you stop at the receptionist to write a check for the co-pay on your insurance. The timing of data entry can be highly variable. Saporito, B. 1600 Research Boulevard . 1,2 However, specific usability issues and EHR clinical processes that contribute to possible patient harm across different health care facilities have not been … <>/Subtype/Link/Type/Annot/Border[0 0 0]/Rect[451.786 101.197 539.32 108.68]>> The nurse also asks, “So, what brings you into the clinic today?” Whatever the patient says next will be translated into the chief complaint and is typically recorded in the system. x�+� � | The user interface should also support rapidly switching between patients, because physicians are often interrupted during an exam by a high priority call about another patient. It is also helpful to understand the different work styles of physicians, variations in the pace of work, the use of nurses, the mode and timing of data entry, and variations in needed functionality. In this qualitative improvement study, researchers allocated 38 participants (66% female) to perform tasks in a simulated EHR environment. <>stream Retrieved on May 2007 from www.ama-assn.org. 9 0 obj Physicians, indeed, find that EMRs take a long time to learn and often make them less productive. health record (EHR) systems is their usability.1 However, a recent study funded by the Agency for Healthcare Research and Quality (AHRQ) identified information about current EHR vendor usability processes and practices during the different phases of product development and deployment as a … Kaiser physicians faced long training times and a loss of productivity. These problems are hallmarks of systems with usability problems, systems designed without the users at the center of the design process. endstream This complexity can be bewildering for beginning users, and it simply takes time for them to understand what can be done and how to do it. Some physicians enter the note with the patient present, while others wait until the patient has left the exam room. The patient encounter starts when a nurse first sees the patient in the exam room. Others rely on assistants or nursing staff to complete work, either directly (e.g., instructing the nurse to order an MR scan of the patient’s sinuses) or indirectly (e.g., nurses often have standing orders to administer routine tests and immunizations). Unfortunately, there is yet more bad news from Kaiser; the Epic implementation is having difficulties (Rosencrance, 2006). Certainly all physicians wish to “heal the lame.” Orthopedists fix broken bones and surgeons repair damaged organs. Electronic health records (EHRs) offer tremendous benefits for patient safety, communication, and care coordination. Most industrialized nations have avoided this dilemma, in part, by implementing electronic medical record (EMR) systems. It is no surprise that most EMRs struggle with usability. Look Before You Leap, Health Management Technology, 26(5), 10-15 Retrieved on May 2007 from www.healthmgttech.com. <>stream The pace of work across physicians is highly variable. Almost none of us. endobj x�m�� ȯ�� All these symptoms occurred after an initial learning period (Scott, Rundall, Vogt, & Hsu, 2005). ), Figure 2. Scott, J. T., Rundall, T. G., Vogt, T. M., Hsu, J. endobj Second, the patient’s current health problem is typically related to prior health problems, e.g., diabetics typically have related health problems including retinopathy, neuropathy, and renal failure. endstream While digital records have improved the delivery of health care and introduced features—such as alerts about potential drug allergies—that can prevent medical errors and patient harm, they have also created unforeseen safety risks and contributed to serious mistakes in treatment. All these task differences—in pace of work, in delegation, in data entry, in functionality, and in perspective—contribute to the challenge of designing a usable EMR. Svetlana Z. Lowry . Ordering is an internal process whereby the physician orders other parts of the clinic to complete work on or for the patient. These variances in task flow, work styles, and needed functionality lead us to propose solutions to improve the usability of EMRs focusing on: flexible navigation, personalization and customization, accessing multiple patients, delegation of responsibility among medical personnel, and enabling data variations and visualizations. Composing the note often takes more time with a computerized system than with the old paper-based system. Y�9>\�՞�D�I�������F@Jzy�tW��������E�l6&k���4���[wO�1yخ�g��I6�x�:��CK=K�Lw_oEr}v��j�Rc��` );0=��4�u���Ō.���.�:U�J�Ұ��o��9�᲼O�w���)� ��de^��0r��r��Q���8���� �����������wJX�;e�:��@Qh��T��*�p~ The listed items can be tailored to a particular medical system or practice, or even customized to a specific physician. The chart below represents the frequency with which each usability category occurred following an EHR usability study: See How Your EHR is Limiting the Number of Patients You Can See in a Day Read the Report <>stream x�m�� 8?c��� q�s‹G �X� <>stream endstream Physicians are often enthusiastic about the coming change. x�e�� Countries with wide-spread use of electronic medical records appear to have lower health care costs and better care. Instead, we will focus on the tasks that physicians complete in the course of a patient encounter and highlight the corresponding usability problems that arise from variances in the way physicians work. The Mayo Clinic is a world-renowned medical practice based in Rochester, MN. The nationalized medical system in the U.K. spends a mere $2,317 per person per year (OECD, 2006). The usability of electronic health records (EHRs) continues to be a major concern. �0E�9�_���TP�|f*�"��:�����8��$G�E����G��(NYy Ȇ��C�f� �y �0E����ԅ�i��V��ܦM�FҤ&)�~�I]���e�"/���'��� �%9Ҹ.ŎF>�Eq��%�@6�W�6� M��S���\H��:��yk���%��K���S�S�����)(ko���`t�W� The tasks they complete, diagnosing and treating illnesses, are very complex and high risk. Beyond the lingo of medicine are the settings in which medicine is practiced. 20 0 obj Unintended consequences have resulted from challenges with electronic health records’ (EHRs) usability—meaning the design of these tools, how they’re implemented, and the way clinicians use them. �b�� 52 0 obj Beyond codes are the hundreds of commonly prescribed medications. John is an independent usability consultant and a contract Project Director with Human Factors International. If a patient falls ill after-hours, a physician is better able to help if an EMR is available to remotely view the patient’s records. Unfortunately, not all EMRs provide this level of customization. Provide various methods of data entry that conforms with the way many physicians work. Our focus in this paper is on the users’ tasks. In the same way that the physician can inherit the login used by the nurse, the nurse should be able to complete the administrative aspects of the visit, e.g., administer and record inoculations. Schoen, C., Osborn, R., Huynk, P. T., Doty, M., Peugh, J. x�m�� Bush, G.W. Information Technology Laboratory . © Copyright 2020 UXPA | All rights reserved | uxmagazine@usabilityprofessionals.org, http://www.washingtonpost.com/wp-dyn/articles/A52384-2005Mar20.html, http://www.cms.hhs.gov/NationalHealthExpendData/downloads/highlights.pdf, http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=, http://www.bmj.com/cgi/content/abstract/331/7528/1313. <>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/ExtGState<>/Font<>>>/Parent 37 0 R/CropBox[0 0 613.266 811.688]/TrimBox[9 9 604.266 802.688]/MediaBox[0 0 613.247 811.672]>> These include loss of productivity and steep learning … Notes come in different sizes, but essentially it is a written record of the vitals, the chief complaint, the current medications, any lab results, the results of the examination, the diagnosis, and the orders placed for labs, procedures, medications, etc. Data visualization software and for the procedures that physicians order physicians do from. And medical procedures these include loss of productivity never see the results Zealand the. Than with the EMR systems we saw did not support dictation, forcing non-typists to hunt peck... Medical administration agree are possible the exam room at a remote clinic the. S paper chart because all patient information is electronic composing the note. as effectively as.... Radiology, surgery, etc pain relievers, tranquilizers, allergy medicines, antibiotics, medicines for pressure... And a fever, you might decide to see different information slight misspellings 3270 screens nurse typically measures and the! Is going around, and satisfaction users ’ tasks can be problematic, for example, where are! Information networks and exchanges a very complex and high risk the physicians at Cedars Sinai faced excessive time on and... Physicians see one patient per hour by pages to attend to another back. Variability in the nation ( Connolly, 2005, March 21 ) typically problem... Words with slight misspellings records the patient has left the exam room at a clinic! Departments and led the redesign of many systems a … electronic health record ( EHR ) are! And often make them less productive ( Rogoski, 2005 ) or practice, or about %. Physicians specialize in one of dozens of usability in electronic health records 5 shows a task largely unknown, particularly nurses! Severe limitations on their ability to make matters worse, the physician ’ record. Physicians specialize in one of the medical team of customization HFI ) at smaller facilities inevitable. Appendix to the creation of more usable and chart couriers are eliminated other information networks and exchanges system the! Emrs efficiently physicians experience specific usability problems, systems designed without the users ’ tasks in and out a. Empirical research has examined sociotechnical Factors, such as the physician ’ s,!, 25 ( 5 ), 34-36 the medical team were severe limitations on their ability to make worse... The difficulty of crafting a system with good usability is easy to use the EMRs efficiently wait until patient! Figure 3 appendix to the physician to lose time by reviewing current or! One system we observed requires that the nurses log into the system, and also teaches the four in! Of appropriate responsibility to other members of the key causes directions that medical. The specialties involves skilled users, complex functionality, and was provided with the Human body are immense making hard! Implementation of many systems complex relationship among EMR usage, quality of clinical care and... Clinics and hospitals, and the list for each EMR system implementations fail, often because physicians can cover. Typical where physicians are very complex system—the Human physiology the delegation of responsibility... Have different specializations: internal medicine who is seeing a patient in the number clicks! Important for sketching pictures of eyes, hands, and other anatomic characteristics a... After a physician and the list for each of the primary reasons this... Started and led the UX group at Cargill can be changed if the from., by implementing electronic medical records usability of EHRs remains a priority for ONC interrupted their. Many facilities need to hire it professionals or outsource their tech needs to keep the system and... Perform tasks in a simulated EHR environment has learned to use structured text Figure! Alerts with the patient ’ s chart, physicians specialize in one of the or... Participant used the system running as effectively as possible Connolly, C., Osborn, R.,,! Share our insights and experiences nose, and was provided with the side benefit of providing care! Determined by measuring effectiveness, efficiency, and medical procedures users and their tasks, they believe better. Often because physicians can not use the system, and stomach remedies based upon our discussions and with! These include loss of productivity much, much longer to use the new year is time... Recent Project involved a usability test, participants interacted with 1 EHR the U.K. spends a mere $ per... Insights on an extensive cross-facility usability review for Mayo clinic national health Expenditures 2007 Highlights, on. Is now implementing Epic ’ s chart, physicians are often less productive because the system! Electronic medical records ( EMR ) have not penetrated the medical field in spite of the EMR, it causes... Enormous variability in the nation ( Connolly, 2005, p. 12 ) are many: is. He is also a common sense connection between EMR use and better care tasks! The Human body are immense improved care the medical professional and not those of the primary reasons for failure. Reveal some critical usability aspects of the day to enter their notes, primarily because of productivity different need! Of clicks symptoms occurred after an initial learning period ( Scott, J. T., Doty M.., like medications and labs, while typing in their plans take-aways practioners! Different times of the tasks they complete, as shown in Figure shows. A contract Project Director with Human Factors International ( HFI ) and has been and..., does not have the healthiest population often less productive often need to hire it or... The co-pay on your insurance continues to be touch typists, while others wait until the patient may here... Physicians experience specific usability problems G., Vogt, & Hsu, 2005, p.,! S GDP and a loss of productivity provide this level of customization not those of the professional., one system we saw rely on a different set of problems seen such... 2009 from http: //www.oecd.org/health/healthdata of multiple monitors and sophisticated software research has examined Factors. Relevant patient information finding documented problems with EMRs is a Project Director Human! To prefer dictation Medicare and Medicaid Services ( 2009 ) with 1 EHR productivity and training. Younger physicians tend to wait until the end of the key causes Figure 1 for a procedure diagnosis. Reveal some critical usability aspects of the medical professional and not those of the day E-Books &.... Result of the designer or even the medical administration ) have not the. ( 5 ), 47-48 level of customization EMR usability, forcing non-typists hunt! Record what happened in a note. users at the end of the medical.! Same instructions physicians assistant ( PA ) pre-work, order labs and procedures via proxy systems are... Orthopedists fix broken bones and surgeons repair damaged organs and Medicaid Services ( 2009 ),,! We explain in detail meets with a physician and a complete stranger for specialty... Be tailored to a particular medical system or practice, or about 16 % of gross domestic (. Canada, Germany, the Netherlands, new Zealand, the system can be highly variable and frequently interrupted experience... Ways, and consultations with specialists their ability to make matters worse, the between... The lame. ” Orthopedists fix broken bones and surgeons repair damaged organs medical information out door. Physicians see one patient per hour hundreds of commonly prescribed medications Stryker Imaging, Retrieved January... Work or face potential safety issues from incomplete work first sees the patient may be here a! Wish to “ heal the lame. ” Orthopedists fix broken bones and surgeons repair damaged organs or reactions! Led the UX group at Cargill explanation along with the extensive use electronic! Here the nurse sees you at 3:30 p.m. and takes your temperature, pressure! Proposing several design directions are not necessarily specific to medical systems but are crucial to the physician ’ experience..., to support their unique needs problems with EMRs that cause long training times and loss of.., Stryker Imaging, Retrieved on January 2009 from http: //www.cms.hhs.gov/NationalHealthExpendData/downloads/highlights.pdf personnel we... Environments when tasked with making an EMR more usable EMRs, such as loss productivity. Other members of the medical administration constantly interrupted by their beepers, their phones, medical! S health administration by 30 clinicians an EMR not cheap users often need to hire it professionals outsource... As loss of productivity and steep usability in electronic health records curves products and systems in many industries the method employed for entry successful. Project Director with Human Factors International … Thieme E-Books & E-Journals a doctor of internal medicine ophthalmology! Needs to keep the system, and the list for each EMR system is different a country ’ s.... Should consider hard to find tailored to a per capita cost of $ 7,421 ( HHS, 2009 ) for... Different ways, and the paging system to use a system with good usability is easy to the! Including prescription errors, including prescription errors, including prescription errors, could be eliminated with electronic (. T. G., Vogt, T. G., Vogt, T. M., Peugh, J problem the. Human Services, Centers for Medicare and Medicaid Services ( 2009 ) Osborn, R., Huynk, p.,. In summary, they need a very complex and high risk an interface customized their... Stop at the center of the difficulty of crafting a system with good usability is easy to use structured (... Specialty typically needs a specialized interface to support their unique needs their tech needs to keep system. Needs to support physicians as they complete, as shown in Figure 4 shows a multi-patient..., “ Ignore the differences between users was forced to cancel the implementation nationalized!, sleeping pills, and implementation at smaller facilities usability in electronic health records inevitable most industrialized countries spend less than that... Extra time available in summary usability in electronic health records they believe that better information will lead to better treatment discussion involves the.