Nine types of usability problems with Electronic Health systems

There is no shortage of complaints about the usability of Electronic Health Record systems (EHRs). More and more evidence is emerging regarding the lack of EHR usability. Speaking at the 2013 Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition, Michael S. Barr, MD, MBA, FACP, of the National Committee for Quality Assurance (NCQA) warned that:

“Satisfaction and usability ratings for certified electronic health records (EHRs) have decreased since 2010 among clinicians across a range of indicators.”

Barr’s presentation at HIMSS focused on “ the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability.”

The healthcare industry in the United States is facing a crisis as medical facilities have spent hundreds of billions of dollars implementing electronic health record (EHR) systems, yet many patients and the physicians and nurses that care for them are seeing few benefits.

In a recent article published in the The Journal of the Human Factors and Ergonomics Society examined 50 studies with the keywords: electronic medical records and electronic health records combined with interface design, usability, safety, and errors published after 2000. Their review of EMR and EHR usability studies revealed nine major types of problems:

1. Naturalness
All information in the display should appear in a natural order. Naturalness also refers to how familiar and easy an application is to use and to what extent it follows the “natural” workflow of the system.

2. Consistency
This principal basically means that knowing one part of an interface should be relevant for use of other parts. A particular system action should always be achievable by one particular user action

3. Preventing Errors
Interactive system interfaces should be designed in a way that prevents errors from happening in the first place

4. Minimizing Cognitive Load
Human short-term memory is limited in capacity (Miller, 1956). Interfaces should be designed in a way to reduce mental workload for users. Users should not have to memorize system information or database content (Molich & Neilsen, 1990).

5. Efficient Interaction
Human–computer interaction should be designed for efficiency by minimizing the number of steps to complete a task or providing shortcuts for users (Belden et al., 2009).

6. Forgiveness and Feedback
Molich and Nielson (1990) wrote that interactive systems should provide feedback in real time in order to keep the user informed about what is currently going on. Appropriate feedback should also inform users about the consequence of actions they are going to make (Belden et al., 2009).

7. Effective Use of Language
Molich and Nielson (1990) wrote that all dialogs should be presented with clear words and phrases that are familiar to users. In the health care domain, there are many terms and abbreviations that may be familiar to specific users but may be meaningless to others.

8. Effective Information Presentation
The design of EMR interfaces, in terms of the amount, type, and organization of information, influences complexity and usability from a user perspective

9. Customizability/Flexibility
Customization is the capability of an EMR interface to be modified based on the needs of each health care provider. Flexibility, or the capacity of an interactive system to be customized, is one of the 14 usability principles identified
by Zhang and Walji (2011) in their research toward developing a unified framework of EMR usability.

Given that these nine types of usability issues persist across many Electronic Health Systems, it is the responsibility of all EHR vendors to reach out to specialists in Healthcare Usability, and solve them. Usability in healthcare is unique in that the creation of more usable systems not only can save these companies money—with reduced development, training, support, and documentation costs—it can save lives!

From: Usability and Safety in Electronic Medical Records Interface Design: A Review of Recent Literature and Guideline Formulation Human Factors: The Journal of the Human Factors and Ergonomics Society August 2015 57: 805-834


The Usability People would welcome the opportunity to work with you on improving the Usability of Healthcare IT.

For expert Safety-enhanced Design (aka Usability) evaluation of your EHR: contact The Usability People

The Usability People

Together we may save a life! #SafeHealthIT