Abstract
Purpose :
Electronic medical records (EMRs) are used in an increasing number of hospitals and office-based medical practices and are the de facto standard of care. EMRs are meant to encourage “meaningful use” of health information technology. However, EMR human-computer usability design may make substantial impacts on doctor-patient relationships and practice workflows. This study seeks to capture, in a meaningful and quantifiable way, the various impacts that the usability of EMR systems make upon the practice of ophthalmology. Further, this study sought to develop a quick and simple way of capturing this data that can be repeated over time and in different settings and different EMR systems.
Methods :
This study proposes a conceptual framework of EMR usability, and measured easily replicable metrics to quantify usability domains including mouse clicks, keyboard to mouse switches, computer screen switches, computer to patient switches, log-ins, and total time spent using the EMR versus patient time in the clinical encounter, that we believe are viable proxies to assess physician-computer usability. Additionally, the study identified multiple task-specific usability metrics. The Epic Kaleidoscope ophthalmology EMR and Topcon Synergy image management system use was studied in all subspecialties, outpatient encounter types, and levels of training at an academic ophthalmology department.
Results :
Our study identified several key EMR usability domains such as overall friction, human-computer related interaction friction, and cognitive clutter in task performance. Additionally, the study identified multiple specific metrics to quantify usability domains. Attending ophthalmology physicians studied spent 41% of clinical encounter times, versus resident ophthalmologists who spent 26% of clinical encounter times, on the EMR. 0% of initial visits and 25% of follow-up visit charting activities were completed within the patient encounter. Surveyed ophthalmologists averaged 1 hour 30 minutes of additional outside charting time per day. The least efficient task type measured was charting visual field tests, which averaged 6 keyboard to mouse switches, and 9 screen switches per test.
Conclusions :
Usability and design features may hinder EMRs' full potential and cause issues with workflow. We were able to identify quantifiable and replicable metrics that can act as benchmarks to continually assess and measure improvements in EMR design.
This is a 2020 ARVO Annual Meeting abstract.