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Nutrition Informatics Blog

Is "Usability" Useful to the User?!

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The concept of “usability” continues to surface during discussions about health information technology and in particular, the use of electronic health records (EHR). 

Usability is defined by the International Organization for Standardization (ISO) as:

….the effectiveness, efficiency, and satisfaction with which the intended users can achieve their tasks in the intended context of product use.

The Agency for Healthcare Research and Quality (AHRQ) recently published an article emphasizing the importance of Usability—or more importantly that “User-Centered Design” (UCD) needs to be considered when designing EHRs and that usability should be tested.

UCD has also been discussed across multiple agencies and experts.  UCD is a process that assures that EHRs are efficient, effective and satisfying to the user.

The National Institutes of Standards and Technology recently partnered with the Office of the National Coordinator (ONC) to provide additional details on how to utilize UCD processes for improving the usability of EHRs.

So why all the talk about usability when so many EHR systems are already designed and in use?

  • Because use of existing systems are often not intuitive—causing the “user” to select screens or options which may not be their desired choice—which wastes time and creates a possibility for errors.
  • Because health care providers do not want to click through a dozen screens to complete their task.
  • Because this is considered a barrier to adoption of EHRs.
  • Because most EHR systems need improvement in this area.

One great benefit of HITECH is that the barriers are front and center—and hopefully competition and innovation will create a glide path for better EHR systems.


A couple of additional reasons that usability testing needs to continue to be a focus.

- EHR usability is directly related to work flow processes. As EHRs are implemented, previously undocumented work flows are being documented and evaluated for effectiveness and efficiency. As the work flow changes based on this new information, so must the computer interfaces that are used to manage that work flow.

- Previously unavailable tools in the realm of information gathering in terms of user reaction to screen inputs are now being more available. For example, Tech Smith now has a product called Morae available that allows software designers not only to record screen content and mouse clicks, but also allows them to record the user so that facial expressions and verbal interaction with the computer can be recorded for evaluated. This essentially allows us to evaluate if a software product is intuitive to the user or based on the record expressions of the user, if the software is increasing the stress level of a user.

User acceptance testing, a normal part of any software release management process will inevitably become its own sub-speciality in the future.
Posted by: John Snyder, DTR, RD at 1/25/2011 8:13 PM


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