This article provides an
evaluation of usability and an introduction of electronic healthcare
systems from a usability, effectiveness and functionality perspectives.
The most important users in EHR systems are those who make decision and
those who solve the problems. It is relevant to have a look at users
experiences in using such systems and find out the importance of
usability. The authentic users in healthcare system should have the
most available tools due to access to the right and sufficient
patient’s health information. The background and related work of this
essay would be an introduction of electronic healthcare systems.
The result of this assessment has proven that EHR systems are somehow
usable if they are implemented carefully with high quality in
configuration according to the users’ need. In fact EHR systems are
necessary for the healthcare systems. The functionality depends on how
the system is integrated and implemented. Consequently, it may give the
satisfactory result for those who seek the information and use the
systems. As a result the system functions effectively.
Introduction
The recent years has brought series of electronic communication tools
that improve health care system. The electronic healthcare record (EHR)
which is replaced the paper based system contains the medical record
that physicians and nurses created and use in their daily routines. The
other authentic health professionals and social workers also employ
this system. Usability of EHR systems should denote the ease of use
with efficiency and help the clinicians to access information. It is
also important for a patient that their health information is recorded
in a secure system that authentic users have access to. An EHR is a
tool to provide sufficient data information for the authentic users.
This paper provides an evaluation of electronic healthcare systems from
a usability, effectiveness and functionality perspectives. It will be
investigated the experiences of previous users of those systems. The
decision makers should have the most powerful tools available to access
to the right information. One assumes that the EHR is more powerful
tool than paper based records with functionality, usability and
efficiency. It helps all users in the healthcare system to perform
their jobs at the high level of quality expected by national and
international standards. One discuss about what makes a system usable
or unusable and why some systems function and some malfunction. The
discussion also contains what makes a system less or more effective.
Materials and Methods
The materials, which are used in this article, are the result of some
evaluation and research that the other researchers conducted, a study
and a short look at an assignment that I have performed by a direct
observation at the St. Olav hospital in Trondheim, Norway.
State of the art
In this section I am focusing mainly on usability, functionality and
efficiency of EHR systems according to some position papers, study and
research result of some researchers.
As we know an EHR system contains all medical information of a patient.
Walsh (2004) indicated, “the clinical usability of electronic records
systems is particularly relevant with the recent appointment of service
providers to implement the National Integrated Care Record Service for
the NHS as usability also affects patient care.”
“Usability concerns whether an information system is structured so that
users can get an answer to fit their purpose.” (Zitner, 2006)
Edwards (2006) presented that” Electronic Medical Records (EMR) and
computerized provider order entries (CPOE) are recognized to improve
quality of care and patient safety. Results indicate users had positive
perceptions of system ease of use after implementation.
Post-implementation ratings were neutral or positive for most users.”
(Edwards, 2006)
“The effects of introducing an EHR system and removing the paper-based
electronic health record might depend on the size of the hospital,
nature of work at the department, functionality in the EHR system
introduced and preparedness, ability and willingness of the hospital
organization to adapt to the changes introduced” (Faxvaag, 2007 (Berg
M, 2001))
What makes a system more or less user-friendly? One believes that
system developers should pay attention to user's real needs and demand.
Thus they can design a system according to their need. In such case a
system can be satisfactory. The easiest way for making a system usable
is to undertake true and realistic testing by the future users of the
system (usability testing). A system should be designed easy to use,
functional, less complicated, eye pleasing and user friendly.
According to Faxvaag et al (2007), “an EHR system provides immediate
access to patient health record information by closing loops in
communication and reducing delays in obtaining records from other
providers. Faxvaag et al (2007) declared, “The-system was useful in
regard to professional learning. It mentioned that it was easy to call
a chief physician who could look up the patient’s case history in the
EMR, or (in less urgent cases) send an electronic note to a chief
physician who would see the memo inhis work-list and could look up the
case when he had time. Further, if someone needed a specialist to
interpret an x-ray image and the physician in question was at the
operating theatre, the picture could be displayed on screen in the
theatre. So, in the same way as the EMR-system was useful to support
quick answers to external calls about inpatient.”
System developers and software programmers usually conduct a usability
testing to measure usability.
According to Møller et.al(2006)”usability testing is a subset of the
field of human-computer interaction that involves applied psychology,
computer science, and information science. Although usability testing
may take different forms, it seeks to assess the functionality of
information technology such as clinical information systems, electronic
documentation, and application software.”
The system designer can continuously maintain a high usability.
Mølleret.al, (2006) has conducted a research on how they could measure
the clinical usability of an EHR configured “by use of participatory
design with clinicians from a neurological stroke unit in order to get
input to the County’s future strategy for incremental implementation of
EHR. The result of Møller’s research in Denmark indicates that EHR can
be usable with good configuration.
Do all clinicians like to use electronic medical records? Walsh (2002)
indicated what Van Ginneken stated, “clinicians reject many
computerised medical record systems because they are not basedon a
story metaphor. " This means that not all users are happy with the
systems. The functionality has not been completely satisfactory.
One conducted an observation on system user activities at the lung
department at St. Olav hospital in Trondheim, Norway. After direct
observation and having some conversations with doctors and nurses, I
discovered that the database could be frustrating sometimes. For this
reason users apply the paper-based records and medical curve. Timing is
very important for them and most of the time they have to wait for
uploading the system due to read patient’s recorded information. It was
also mentioned that patients want that their medical information be
confidential and secure.
Professor Pieter Toussaint mentioned in his lecture on evaluation in
April 20th 2007 that in Netherlands a few years ago, a system was
implemented due to facilitate the prescription procedures through an
EHR system. Doctors could send the prescriptions directly to the
pharmacies where a patient could receive their medicine. The system
caused lots of death. That’s why most of the non-registered patients
whose history was not recorded at the hospitals got wrong medicine.
Consequently they received side effects and some of them even died. The
researchers and clinicians explored that the problem was a insufficient
and incorrect implementation. The system was not only ineffective but
also resulted a national problem!
There have been made many studies on usability of EHR systems. Angermo
et.al (2006) provided valuable information about the usability of NIC
as a classification system for use in Electronic Health Record (EHR)
systems. “The study was about nursing interventions documented in
cancer patients' records and an analysing of their types and the
degree, which were classified with the Nursing Intervention
Classification(NIC).”
Discussion and Conclusion
In this report I have presented in short usability, functionality and
efficiency of EHR systems. The main purpose of usability factor for
computerized systems is that it promotes an increase in user
performance. Better performance means more gets done. One of the
drawbacks of having a system that creates and enhancement of
performance is that it requires more skills of the users. It is crucial
that the right systems are put in place that suits the needs of their
users. Being that the health care system is a high-quality environment,
it is necessary that these systems work with at a high-quality level as
well. It is clear to see from (figure 1), that since implementing the
new systems, user performance has increased, over the previous ways.
After researching about the usability factor, it is apparent that most
users prefer the organized method of data entry, filing and access
abilities. With a more organized and secure method of record keeping,
client data is kept safe.
Looking at the results of the research, it is quite clear that not all
users were happy with the computerized method. There were satisfied
with the way things more comfortable. Individual understanding by
employees can create usability complications resulting in a disruption
of performance. While the usability factor can seem important, if a
system is slow moving, it cannot work properly or as efficiently as it
should. While a new form of data keeping using computers can seem like
the right move, it is not always the case. Performance is the key to
implementing a highly efficient functioning component of the job.
It is not uncommon to find out that some of the users are not
completely satisfied with slow-moving systems that take up too much
time. While implementing a health care access system, we need to focus
mainly on the user’s needs. There are only two stakeholders generally
the organization disseminating information and the users who can use
information for their benefit. On the other hand while implementing an
EHR system in a corporate environment the designer faces a tougher
challenge. The usability of EHR to employees and users is one issue,
the usability of products and a system as a whole can be increased by
the implementation of it, which is a broader second issue.
Three crucial functions may be performed due to increase usability of
an EHR system. First, it should help in getting feedback from the
users, services and send them to the developers, facilitate discussion
among the software developers who design the system and users. This
will give deeper insight to the product development team to acknowledge
consumers need. The second aspect is to facilitate the communication
between stakeholders and top brass of the organization, which will help
in making decision process democratically. Every stakeholder will feel
attached to the organization and as a result the longevity of
organization will be ensured. A third objective would be to preserve
historical.
In conclusion one can imply that the usability of EHR systems is
dependent on the high functionality, efficiency and implementation. An
EHR should contain sufficient information of the patients and clinical
records. It should be secure, confidential and usable for many
authorized users to be able to view the records. Learning is another
factor that we should not forget. The newbie in healthcare system
should be able to learn from an EHR system. One should also have the
ability to measure the health status so that a doctor may be able to
help patient in most effective way. A wrong implemented of an EHR
system can lead to national catastrophes such as what happened in
Netherlands a few years ago. One cannot deny the fact that the EHR
systems are more used than paper-based systems. Although there were
occurred some mistakes in the past, but such systems help the authentic
users to perform their jobs at the high level of quality, low cost and
save their time.
List of definitions
CPOE = Computerized provider order entry
EHR = Electronic health record, repository of information regarding the
health of a subject of care in computer processable form
EHR-system = computer application for obtaining, archiving and
distributing EHR’s
EMR= Electronic Medical Records
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