Resident Identified Violations of Usability Heuristic Principles in Local Electronic Health Records

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Abstract
Introduction. Difficulties with the electronic health record (EHR) are known to be associated with high physician burnout. Usability studies can evaluate and identify usability issues with the EHR at the end user level. This study was conducted to determine physician perspectives and usability issues of local EHR systems. Methods. Survey and focus group methodology were employed. Participants were resident physicians who were members of a resident council in the Midwest. Survey data collected included demographics and perceptions. Focus group data included participants identification of usability principle violations and potential impact to end user. Results. There were 15 survey respondents (across 11 residency programs) who reported use of three different EHR systems: Cerner®, Meditech, and Computerized Patient Record System (CPRS). Satisfaction was greatest with Cerner® as well as most reported level of experience. Focus group respondents reported a variety of usability violations which lead to provider confusion, increased time, alert fatigue, and potential patient safety issues. Discussion. Violations of usability principles can result in disruption of physician workflow processes and lead to increased documentation time as well as fatigue. These issues have been associated with increased provider burnout. Continuous usability assessments should be conducted at the end user level to promote the development of more effective and efficient EHR interface designs.

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