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Maria Johnsen's research

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Evaluation of Usability and an Introduction of EHR Systems

Are EHR systems usable, effective and functional?


This research 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 explore 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.

Evaluation of Usability and an Introduction of EHR 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. A complicated system increases frustration and dissatisfaction. Software engineers should pay attention to develop health care systems which is simple to use. As a result the system functions effectively.


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.

Evaluation of EHR systems

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 in his 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 theater, the picture could be displayed on screen in the theater. 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 Moller 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. 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 Moller'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 in order to read patient’s recorded information. Patients wish their medical information wbe 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 is 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 an insufficient and incorrect implementation of EHR system. The system was not only ineffective but also resulted a national problem.

There have been made many studies on usability of EHR systems. Angermo (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 analyzing of their types and the degree, which were classified with the Nursing Intervention Classification (NIC).

Evaluation of Usability and an Introduction of EHR Systems

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 an enhancement of performance is that it requires more skills of the users.Not everybody is computer literate. It is crucial that the right systems are put in place that suits the needs of their users. Having said 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 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. 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 too slow to upload, it cannot work properly or as efficiently as it should be. 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.

Some of the users are not completely satisfied with slow 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 should be implemented in 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 for users. This will give deeper insight to the product development team to understand users need. The second aspect is to facilitate the communication between stakeholders and the head of the organization, which will help in making decision process democratically fast. 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 data.

In conclusion it is fair to say 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. Thus complexity of using the system makes things difficult to grasp. It is recommended having the ability to measure the health status so that a doctor will be able to help patient in most effective way. A wrong implemented 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


Arild Faxvaag ,Hospital physicians' tasks and the use and nonuse of EHR-system functions Retrieved 04.26.2008

Arild Faxvaag,Jan Tore Lium "Removal of paper-based health records from Norwegian hospitals: Effects on clinical workflow" Retrieved 05.04.2008

Berg M. Implementing information systems in health care organizations: myths and challenges. International Journal of Medical Informatics 2001;64(2-3):143.

David ZitnerPhysicians will happily adopt information technology, retrieved 04.26.2008

Edwards, Paula Jean, Electronic medical records and computerized physician order entry: Examining factors and methods that foster clinician IT acceptance in pediatric hospitals retrieved 04.26.2008

John MoLLER-JENSENa,1, Ivan LUND PEDERSENb and Jesper SIMONSENc Measurement of the Clinical Usability of a Configurable EHR, Ubiquity: Technologies for Better Health in Aging Societies A.Hasman et al. (Eds.)IOSPress, 2006 © 2006 Organizing Committee of MIE 2006

Linda E. Moody, PhD, MPH, FAAN; Elaine Slocumb, PhD, RN; Bruce Berg, MD; Donna Jackson, MSN, RN, "Electronic Health Records Documentation in Nursing: Nurses' Perceptions, Attitudes, and Preferences" retrieved 04.26.2008

Stephen H Walsh, The clinician's perspective on electronic health records and how they can affect patient care,retrieved 04.26.2007

Angermo LM, Ruland CM. (2006)Increasing the usability of nursing intervention classification in EHR's. Retrieved 05.04.2008

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