EHRs Lack Standards, Best Practices

Vendors support an independent body to develop best practices and usability standards for electronic health record products.
The majority of vendors also said that usability assessments and evaluations are not a common activity during the design and development process. "There was a common perception among the vendors that usability assessments are expensive and time consuming to implement during the design and development phase," the report said.

The document went on to say: "Although vendors described an array of usability engineering processes and the use of end users throughout the product lifecycle, practices such as formal usability testing, the use of user-centered design processes, and specific resource personnel with expertise in usability engineering are not common."

Additionally, end-user involvement during product development is often limited to workgroups, advisory panels, or clinicians who have a strong interest in technology and are part of an academic medical center. Vendors say they turn to these groups to provide feedback when developing initial product requirements, evaluating wireframes and prototypes, and participating in initial beta testing.

Based on its findings the AHRQ made the following eight recommendations.

  • Encourage vendors to address key shortcomings that exist in current processes and practices related to the usability of their products. Most critical among these are lack of adherence to formal user-design processes and a lack of diversity in end users involved in the testing and evaluation process.

  • Include in the design and testing process, and collect feedback from, a variety of end-user contingents throughout the product life cycle. Potentially under sampled populations include end users from nonacademic backgrounds with limited past experience with health information technology and those with disabilities.

  • Support an independent body for vendor collaboration and standards development to overcome market forces that discourage collaboration, development of best practices, and standards harmonization in this area.

  • Develop standards and best practices in use of customization during EHR deployment.

  • Encourage formal usability testing early in the design and development phase as a best practice, and discourage dependence on post-deployment review supporting usability assessments.

  • Support research and development of tools that evaluate and report EHR ease of learning, effectiveness, and satisfaction both qualitatively and quantitatively.

  • Increase research and development of best practices supporting designing for patient safety.

  • Design certification programs for EHR usability in a way that focuses on objective and important aspects of system usability.