How to choose a usable Electronic Health Record (EHR) system

The usability of the system is the probably most important factor in making an informed choice of which EHR to use for your practice. Most every bit of software says that it is easy to use, but how can you choose an EHR that is actually usable?


We recommend choosing an EHR that is ONC Meaningful Use Stage 2 certified. The MU2 certification program requires that EHR vendors have a user-centered design approach, and submit a summative usability evaluation as part of their §170.314(g)(3) Safety-enhanced design certification submission. These usability documents are made available to the public on the CHPL site ( http://oncchpl.force.com/ehrcert ).

Being MU2 certified, however, doesn’t mean that the system is usable. You really need to take a critical look at the results presented in the usability report that was conducted as part of the EHR vendors submission.

Look at the published usability document for the EHR that you are considering. The first thing that you should look at is the SUS. The System Usability Scale (SUS) is a simple, 10-item Likert-type attitude scale providing a global subjective assessment of usability from the user’s perspective (John Brooke at Digital Equipment Company developed the SUS in 1986). The SUS scale is scored from 0 to 100; scores under 60 represent systems with poor usability, scores over 80 are considered better than average.

Think of the SUS like your high school math tests, above 60 percent is passing, 80 percent is a “B” , etc. The rating gives a very accurate indication of the overall usability of the system. Stay away from an EHR that gets less than a 60.

The next thing we recommend you take a look at in the report is the average overall completion rate. The percentage of tasks were successfully completed by the participants in the study gives an accurate gauge of the ease-of use of the system when performing common data entry tasks.

Be wary of studies that claim a 100 percent task completion rate.

Finally, we recommend that you take a look at the number of, and the background of the participants used in the study. We’ve seen some studies published on the CHPL site that have two or fewer participants, and some of those participants were employees of the company (note: these are the studies that also tend to have a 100 percent completion rate). Unfortunately ONC has not specified a minimum number of participants for the certification. The bare minimum number of participants should be 5. The more participants the better, but we think that 10 to 12 is a great compromise between amount of data to analyze/report and the overall cost of the evaluation.

Think about this: If a EHR vendor took short-cuts in preparation of their usability evaluation, what other short-cuts did they take with development of their system?

Extra credit: Look at the table of participant demographics. These participants should be a mix of doctors, nurses, admins, etc. with a mix of experience with the system, not just current users of the system.

Usability is defined as the effectiveness, efficiency and satisfaction of a system.

An EHR needs to work (effective), work well (efficient), and not cause any unnecessary frustration (satisfying) . Choosing a usable system will improve your bottom line.