Clinicians need more information to make proper EHR purchasing decisions

As the influence and importance of electronic health records (EHRs) continues to grow, do hospitals and private practices have enough information to purchase the right system for their specific needs?

According to a recent study published in Journal of the American Medical Informatics Association, today’s EHR marketplace does not provide purchasers with sufficient information on usability, making it harder to compare these complex products with one another.

“Product comparison tools would support market forces by better informing purchasers about the usability of EHRs prior to making a purchase decision, and would consequently push EHR vendors to compete more on usability,” wrote lead author Raj M. Ratwani, PhD, MedStar Health’s National Center for Human Factors in Healthcare, and colleagues. “Although many providers have already adopted EHR technology, there has been an increase in the number of providers switching EHR products. However, until robust EHR usability comparison tools exist, purchasers do not have the usability information they need to inform their decision-making. Thus, vendors may be less likely to aggressively compete on usability, since it is not a major factor in the purchasing process.”

Ratwani et al. noted that the Office of the National Coordinator for Health Information Technology (ONC) has put certain certification requirements in place that require vendors to “provide a statement attesting to use of a user-centered design (UCD) process” and “conduct a formal usability test, called a summative test, on their products,” but vendors regularly receive certification without complying.

That UCD process is significant, the authors said, because it “lays the foundation” for an EHR that supports its users.

“Although many mistakenly believe that usability is simply determined by the design of the visual display or user interface, a rigorous user-centered design process is based on a deep understanding of how front-line clinicians conduct their cognitive and task-oriented work, and leveraging this knowledge to guide design and development of the product,” the authors wrote.

So how can purchasers compare the usability of different products before they pull the trigger? According to Ratwani and colleagues, it’s not easy. They suggest modifying the ONC’s requirements, making vendors go beyond just “attesting” the use of a UCD process and providing proof that the UCD process works. This could be done through providing user reviews, test cases or another similar method.

“The evidence would provide insight into the rigor of the UCD process, as is done by the FDA with the testing of medical devices, and this information would support comparison across vendors,” the authors wrote.

Barriers to making proper usability comparisons also exist after implementation. One reason for this, Ratwani and colleagues explained, is that EHRs go through so much customization as they are implemented into a facility. This makes it more difficult to compare one system’s effectiveness with that of another; when the situations aren’t the same, comparisons don’t have the desired impact.

The authors suggest that one potential way to overcome that issue would be comparing user interaction data such as the time it takes place a medication order. And if the ONC is able to improve post-market surveillance of EHR products, that could also make a significant difference.

Overall, purchasers will be left to make decisions with the information currently available. But, the authors concluded, teamwork on numerous levels could make the entire purchasing process much more straightforward and helpful.

“Overcoming the barriers described here will require cooperation from numerous stakeholders, including the ONC, EHR vendors and providers,” the authors wrote. “Until free market conditions can push vendors to aggressively compete on usability, ONC certification requirements will remain the primary lever for promoting usability, even though vendor adherence to these requirements remains subpar.”