Improving safety through usability measurement
This year World Patient Safety Day, Sept. 17, is focused on clinicians. Does it seem strange to focus on clinician safety and well-being on a day dedicated to patient safety?
The reason for this dedication is because clinicians who are burdened are more likely to be involved in patient safety incidents. Burnout can also cause depersonalization with patients and impaired attention and memory which can lead to errors. Improvements in the usability of health information technology can reduce burden/burnout and improve patient safety. Data and measurement can help us to see better how usability can improve patient safety.
The relationship between usability and burnout
In a study in early 2020, the Mayo Clinic evaluated the usability of electronic health records (EHRs) across many organizations in the US (using the industry-standard System Usability Scale) and burnout rates (using the Maslach Burnout Inventory) to better understand the relationship between perceived usability and burnout.
What they found was that a 1-point improvement in the usability score was associated with a 3% reduction in the likelihood of burnout. The fact that usability and burnout are connected is important to reinforce with data, but the biggest takeaway is that even small improvements in usability can have a tangible influence on the reduction in burnout, which has practical impact on patient safety. The improvements around reducing cognitive burden are directly related to improved usability.
Another study evaluated perceived usability with the EHR and interactions with patients also using the System Usability Scale. Higher physician perceived EHR usability was associated with higher levels of perceived positive outcomes (improved patient care) and lower levels of perceived negative outcomes (worse patient interactions and work-life integration). This study found that each 1-point improvement in the usability score was associated with a higher likelihood of that the EHR in the examination room rarely or never distracts from interacting
with patients that using the EHR at home rarely or never has an adverse effect on work-life balance.
A valuable view of the clinician experience
It’s possible to also go beyond subjective measures of usability to paint a broader picture and to evaluate which usage changes relate to perceived usability. Evaluating data related to efficiency, effectiveness, and the impact on clinician burden collected from actual EHR usage has been shown to provide a valuable additional view of the clinician experience. A recent study suggests 7 core measures of EHR use including time working outside of work, time on inbox, and amount of undivided attention.
Allscripts commitment to improve patient safety
At Allscripts as part of a rigorous user-centered design process, we define measurable usability goals that we want to achieve prior to starting an update or new design and then evaluate using subjective and objective measures throughout design, development, and after implementation.
Measurement helps us to be intentional about design and make everyone on the team aware of how we will measure the product. Improving usability and reducing clinician burden is vital for improving patient safety and measurement is a tool that vendors and health care organizations need to include in their efforts.