Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating

Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason for slow adoption is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and "meaningful use" will require that efficiency and usability be effectively addressed at a fundamental level. We conducted a literature review of usability principles, designating key principles as simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context. Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost-efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results.