March 31, 2009

The recently-passed American Recovery and Reinvestment Act of 2009 dedicates a large part of its girth to the Health Information Technology for Economic and Clinical Health Act (HITECH Act).  With $18 billion for “computerizing Americans’ health records, reducing medical errors, and saving billions in health care costs” (see, the Health IT (HIT) market is likely to experience massive growth.  But how does this apply to usability?

We’ve been monitoring the wire; there is daily gnashing of teeth in the press, on blogs, and in the ether about the difficulty of using HIT systems. What’s more, “usability” is not currently a criterion used in certifying Electronic Health Record (EHR) vendors.  Indeed, a growing list of published research in reputable journals indicates usability is one of the key barriers to user adoption of EHRs and a principal reasons for user rejection once they are implemented.

For the health IT industry to achieve the “meaningful use” that the HITECH Act demands, we believe usability will have a much greater impact on EHR adoption than security, privacy and systems integration. The notion that highly-trained and time-pressured physicians would be primarily responsible for data entry into EHR systems amplifies the need for efficient and easily learnable applications. 

So we asked a very simple question: Do organizations even consider usability when selecting an EHR? To answer this, we performed a content analysis of Requests for Proposal (RFPs) and RFP frameworks issued by government entities, professional organizations, and non-profits. (This is typically how organizations start the EHR vendor selection process and allows them to specify product requirements.) We analyzed more than 40 RFPs for their degree of sophistication in demanding a high-level of usability from vendor applications.

User Centric found a very small percentage of these RFPs even mentioned user experience. Of the 43 RFPs we examined, 21 had zero selection criteria related to usability, 16 had minimal or superficial usability requirements, 5 were classified as “fair” and only 1 was “good”. (Visit to download full study plus recommendations)

This suggests a paradox: Usability is a huge concern among clinical staff and can have major impact on clinical productivity and cost, but little concern for usability is reflected in the formal procurement process. The challenge is to educate purchasers of Health IT applications about the importance of usability and its impact on clinical productivity. 

Another usability challenge is the personal health record.  The HITECH Act identifies Personal Health Records (PHRs) as an individual patient's electronic healthcare record that can be drawn from multiple sources and is managed, shared, and controlled by the patient. User Centric recently released a white paper that compared online PHR applications.  Based on this study, User Centric has developed a set of usability guidelines for PHR applications that would make these applications. (Visit to download full study and guidelines)

Physicians, HIT integrators, and solution vendors have made it unambiguously clear to us that improving product usability will increase the willingness of clinical staff to use HIT solutions.  In recognition of this, User Centric has announced two new usability service offerings specifically for the health care industry: Interface Productivity Evaluation™ for healthcare organizations (HCOs), and Usability Diagnostics™ for HIT application providers.

The question looming now is "How can we get physicians and individuals to use these electronic applications?" Through user research and user-centered design, the HIT industry now has greater opportunities for increasing widespread EHR and PHR adoption. 

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