How Many Clicks Does It Take to Order a Tylenol Pill?
The conversion to electronic health record (EHR) is supposed to improve patient care and medical error by
Improving the accuracy and clarity of medical records
Making the health information readily available to the health care team, thus minimizing duplication of tests and delays in treatment
Allowing patients to more actively participate in their own care and make better healthcare decisions
However, healthcare providers continue to find EHRs challenging, especially when it comes to user experience. Usability challenges lead to inefficiencies that contribute to clinician frustration and patient dissatisfaction. Common complaints include screen displays that have confusing layouts and extraneous information coupled with workflow sequences that are redundant and burdensome. Then, there are alerts that interrupt workflow with irrelevant information.
A study (J Am Med Inform Assoc., 2018) illustrates the wide variability in task duration, clicks, and accuracy when completing basic EH functions across EHR products from the same vendor and between products from different vendors. Time and the number of clicks to perform certain tasks varied almost tenfold.
For example, a simple order of Tylenol had an error rate ranging from 0 to 30 percent. It took from a low of 14 clicks to a high of 62, with a time range from 45 seconds to 1 minute 10 seconds.
Why do these variations occur, considering that EHR vendors are required to provide a user-centered design approach and conduct usability testing of certain EHR features near the end of the development process? A major culprit is local site customization, meaning that the layout and type of information presented on the screen can be altered. There are no performance guidelines or mandated requirements for testing the usability and safety of implemented EHRs. Perhaps the time has come for mandated performance standards to help ensure that all implemented EHRs have usable and safe systems that reduce both medical error rate and click rate.
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