Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records

Applied Clinical Informatics · 12 authors, 5 centres

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TL;DR

A cross-sectional survey of ambulatory clinical staff at two campuses found that ordering providers perceived lower EHR usability than non-ordering providers, and usability perceptions varied significantly between the EpicCare and Allscripts EHR systems. Prior EHR experience did not strongly predict usability perceptions.

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This cross-sectional study surveyed ambulatory clinical staff at two campuses (CU and WC) of a major academic health system to compare usability perceptions of EpicCare and various iterations of Allscripts EHRs before an EHR transition. Using the Health Information Technology Usability Evaluation Scale (Health-ITUES), the study assessed four usability constructs: Quality of Work Life, Perceived Usefulness, Perceived Ease of Use, and User Control. The central results indicated that ordering providers (OPs) consistently reported lower usability scores than non-ordering providers (non-OPs) and were more affected by the specific EHR system. While EpicCare was perceived as more usable for tasks like care coordination and documentation, both systems showed low scores for tab navigation and cognitive burden reduction. Prior EHR experience was not a significant predictor of usability perceptions. Limitations include a low survey response rate, potential nonresponse bias, unmeasured specialty-specific workflow differences, and different data collection periods for the two campuses, with one occurring during the COVID-19 pandemic. The findings suggest that EHR implementation strategies should account for differences in clinical roles and that addressing cognitive burden is critical for improving usability.

STUDY TYPE

cross-sectional

SPECIALTY

research methods

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ORIGINAL PAPER

PMC10306987

Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records

Applied Clinical Informatics

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ABSTRACT

Abstract Background A growing body of literature has linked usability limitations within electronic health records (EHRs) to adverse outcomes which may in turn affect EHR system transitions. NewYork-Presbyterian Hospital, Columbia University College of Physicians and Surgeons (CU), and Weill Cornell Medical College (WC) are a tripartite organization with large academic medical centers that initiated a phased transition of their EHRs to one system, EpicCare. Objectives This article characterizes usability perceptions stratified by provider roles by surveying WC ambulatory clinical staff already utilizing EpicCare and CU ambulatory clinical staff utilizing iterations of Allscripts before the implementation of EpicCare campus-wide. Methods A customized 19-question electronic survey utilizing usability constructs based on the Health Information Technology Usability Evaluation Scale was anonymously administered prior to EHR transition. Responses were recorded with self-reported demographics. Results A total of 1,666 CU and 1,065 WC staff with ambulatory self-identified work setting were chosen. Select demographic statistics between campus staff were generally similar with small differences in patterns of clinical and EHR experience. Results demonstrated significant differences in EHR usability perceptions among ambulatory staff based on role and EHR system. WC staff utilizing EpicCare accounted for more favorable usability metrics than CU across all constructs. Ordering providers (OPs) denoted less usability than non-OPs. The Perceived Usefulness and User Control constructs accounted for the largest differences in usability perceptions. The Cognitive Support and Situational Awareness construct was similarly low for both campuses. Prior EHR experience demonstrated limited associations. Conclusion Usability perceptions can be affected by role and EHR system. OPs consistently denoted less usability overall and were more affected by EHR system than non-OPs. While there was greater perceived usability for EpicCare to perform tasks related to care coordination, documentation, and error prevention, there were persistent shortcomings regarding tab navigation and cognitive burden reduction, which have implications on provider efficiency and wellness. Keywords: electronic health records, user-centered design, medical informatics applications, job satisfaction

CITATION EXPORT

Brian Lefchak, Susan Bostwick, Sarah Rossetti et al.. Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records. Applied Clinical Informatics. (2023). https://doi.org/10.1055/a-2074-1665

AUTHORS

12 · 5 CENTRES

Brian Lefchak, Susan Bostwick, Sarah Rossetti, Kenneth Shen, Jessica Ancker, Kenrick Cato, Erika L Abramson, Charlene Thomas, Linda Gerber, Amanda Moy, Mohit Sharma, Jonathan Elias

1NewYork-Presbyterian Hospital, New York, New York, United States
2Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
3Department of Biomedical Informatics, Columbia University, New York, New York, United States
4Columbia University School of Nursing, New York, New York, United States
5Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States