A paper published in the Journal of the American Medical Informatics Association this past week found that, while electronic health record vendors have demonstrated promising levels of advancement, EHR usability continues to be a major hurdle after implementation.

The paper – authored by MedStar Health’s Dr. Aaron Z. Hettinger and Raj M. Ratwani, along with Yale School of Medicine’s Dr. Edward R. Melnick – examined the usability practices of four unnamed EHR vendors.  

“Implementation processes such as healthcare-facility configuration and customization choices, training and policy all impact usability of EHR technology,” noted Hettinger, Melnick and Ratwani.   

“The difference between EHR products pre- and post-implementation, called the EHR usability reality gap, continues to be a significant challenge,” they continued.


The authors noted that the Office of the National Coordinator for Health IT’s basic certification requirements apply to the product as developed by the vendor – and using the software in the real world may be a dramatically different experience.   

All four vendors, they said, described a focus on end users of the product, the importance of understanding the context of use and the incorporation of user feedback throughout product development.   

Some have also begun to recognize the different sociotechnical systems – such as the personnel, hardware, software and culture of the organization – that can shape EHR usability.

All that is good news for usability measures.  

However, wrote the researchers, “Because most healthcare facilities do not have enough or appropriately trained workforce to optimally configure and usability- or safety-test their product, frontline clinicians interact with a system that may be vastly different from what was originally tested by the vendor.”

The researchers observed that three of the four vendors are working to address this so-called usability reality gap. One provides customers with a usability training toolkit, while another gives facilities greater expertise to optimize product configurations. A third takes a user-centered design approach throughout the product lifestyle.  

“These types of practices are critically important steps to improving EHR usability and should be adopted by all EHR vendors,” wrote the authors.  

There are still areas for continued improvement, particularly with regard to the effect of usability on patient safety and benchmarking.  

“Ensuring that rigorous methods for measuring efficiency, effectiveness, satisfaction, and safety, beyond the [system usability scale], is important to improving EHR usability across all products,” the paper read.  


Questions of EHR usability have loomed over vendors for years, with a Mayo Clinic study linking it with clinician burnout in 2019.  

“The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability,” wrote the authors.  

But amid the unprecedented stress of the COVID-19 pandemic, some companies have taken action to improve their user interface and experience.  

“The process for customizing EHRs across an organization has to include all stakeholders, and not be designed according to the preferences of a limited set of clinicians,” said Amy Heymans, founder and chief experience officer at the design agency Mad*Pow, this past December.


“Moving forward,” the researchers wrote, ” it will be important to continue to have usability as a top priority, and to ensure that safety becomes a top priority, for all stakeholders, including vendors, healthcare facilities, researchers, policymakers, and patients who all have shared responsibility for effective EHR technology.”

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.