Usability and Success – Are We There Yet?

Patricia Diggs and Wil Yu | December 27, 2011

Since the inception of the 2009 HITECH Act, we’ve heard concerns about the challenges providers face in achieving Meaningful Use of electronic health records (EHRs). One issue is the concern about “Usability” or “User Experience,” as it is more affectionately known.

In its effort to accelerate the implementation of EHRs nationally, the Federal government wants systems that are secure, interoperable, perform meaningful functions, and … that’s right… usable. The term “Usability” refers to how easily and effectively users can use a product to achieve their goals and their satisfaction with that process.

In October, the Strategic Health IT Advance Research Projects – Cognitive (SHARPC) hosted a lively discussion at The EHR Usability Symposium, “Usability, Present and Future,” a symposium of the annual AMIA conference held in Washington, DC.

A host of physicians, researchers, vendors, stakeholders, and Federal policy makers attended the symposium; all of whom had strong opinions and perspectives on which methods would achieve the goals of enhanced user experience in EHRs.

Hospitals, medical offices of all sizes, and EHR vendors all agree, we need to not only implement EHRs to improve clinical outcomes and make health care more efficient, but the tools and methods need to be usable in order to achieve Meaningful Use. So the question still remains, how do we get there and which path do we take?  Through a Federal grant and cooperative agreement, the SHARPC program has taken the lead in this challenge.

Addressing Usability Challenges to Achieve Meaningful Use

For the past year, the SHARPC-Project 1 has focused on the development of a cognitive support system that can assist physicians in their decision-making. Through their advanced research, SHARPC has studied the current and future approaches to EHR usability. Through continued work, SHARPC anticipates that the tools and methods developed from this research will help improve the adoption and Meaningful Use of EHRs by addressing Usability challenges.

It was not surprising to find some of the presenters at the symposium had simple and straightforward ideas about how to improve usability, including new ONC staff member Jacob Reider, MD. “We all need to listen to each other’s ideas, and know that there is no right or wrong answer to this issue. We are all learning this together, and we all want the same thing,” Dr. Reider observed.

Understanding Usability through the User Experience

Dr. Reider talked about the continuum of User Experience and provided a framework for how we can view the evolution of any new tool or application:

Functional (it does what it is claimed to do)

Reliable (it works consistently)

Usable (it works in a way that is consistent with the user’s expectations)

Meaningful (it does something important or valuable)

Pleasurable (it is enjoyable to use)

In addition to Dr. Reider’s framework, there were also those who came with mathematical equations and complex scientific algorithms for understanding usability. The researchers provided an in-depth outlook on the science, while others expressed passionate thoughts about what systems and processes should be developed and implemented in order to enhance the usability of EHRs. They discussed the past, present and future of usability, and it was evident we still have work to do.

It’s clear that we are making progress. We must now collaborate on the next steps to be successful. To summarize in a relatable perspective, just as a family traveling on a long road trip with kids, the one question that is constantly asked….- Are we there yet? Parent’s response – Well, not yet, but we’re certainly getting close

Additional details on the SHARP program may be found at:

Additional details on the SHARPC program’s usability efforts may be found at: