Evaluation of Usability and an Introduction of EHR Systems

"Are EHR systems usable, effective and				County's future strategy for incremental
functional?"				implementation of EHR.
Abstract				The result of Møller's research in Denmark
This article provides an evaluation of usability and				indicates that EHR can be usable with good
an introduction of electronic healthcare systems				configuration.
from a usability, effectiveness and functionality				Do all clinicians like to use electronic medical
perspectives.The most important users in EHR				records? Walsh (2002) indicated what Van
systems are those who make decision and those				Ginneken stated, "clinicians reject many
who solve the problems. It is relevant to have a				computerised medical record systems because
look at users experiences in using such systems				they are not basedon a story metaphor. "
and find out the importance of usability. The				This means that not all users are happy with the
authentic users in healthcare system should have				systems. The functionality has not been
the most available tools due to access to the				completely satisfactory.
right and sufficient patient's health information. The				One conducted an observation on system user
background and related work of this essay would				activities at the lung department at St. Olav
be an introduction of electronic healthcare				hospital in Trondheim, Norway. After direct
systems.				observation and having some conversations with
The result of this assessment has proven that				doctors and nurses, I discovered that the
EHR systems are somehow usable if they are				database could be frustrating sometimes. For this
implemented carefully with high quality in				reason users apply the paper-based records and
configuration according to the users' need. In fact				medical curve. Timing is very important for them
EHR systems are necessary for the healthcare				and most of the time they have to wait for
systems. The functionality depends on how the				uploading the system due to read patient's
system is integrated and implemented.				recorded information. It was also mentioned that
Consequently, it may give the satisfactory result				patients want that their medical information be
for those who seek the information and use the				confidential and secure.
systems. As a result the system functions				Professor Pieter Toussaint mentioned in his lecture
effectively.				on evaluation in April 20th 2007 that in
Introduction				Netherlands a few years ago, a system was
The recent years has brought series of electronic				implemented due to facilitate the prescription
communication tools that improve health care				procedures through an EHR system. Doctors
system.The electronic healthcare record (EHR)				could send the prescriptions directly to the
which is replaced the paper based system				pharmacies where a patient could receive their
contains the medical record that physicians and				medicine. The system caused lots of death. That's
nurses created and use in their daily routines. The				why most of the non-registered patients whose
other authentic health professionals and social				history was not recorded at the hospitals got
workers also employ this system. Usability of EHR				wrong medicine. Consequently they received side
systems should denote the ease of use with				effects and some of them even died. The
efficiency and help the clinicians to access				researchers and clinicians explored that the
information. It is also important for a patient that				problem was a insufficient and incorrect
their health information is recorded in a secure				implementation. The system was not only
system that authentic users have access to. An				ineffective but also resulted a national problem!
EHR is a tool to provide sufficient data information				There have been made many studies on usability
for the authentic users. This paper provides an				of EHR systems. Angermo et.al (2006) provided
evaluation of electronic healthcare systems from				valuable information about the usability of NIC as
a usability, effectiveness and functionality				a classification system for use in Electronic Health
perspectives. It will be investigated the				Record (EHR) systems. "The study was about
experiences of previous users of those systems.				nursing interventions documented in cancer
The decision makers should have the most				patients' records and an analysing of their types
powerful tools available to access to the right				and the degree, which were classified with the
information. One assumes that the EHR is more				Nursing Intervention Classification(NIC)."
powerful tool than paper based records with				Discussion and Conclusion
functionality, usability and efficiency. It helps all				In this report I have presented in short usability,
users in the healthcare system to perform their				functionality and efficiency of EHR systems. The
jobs at the high level of quality expected by				main purpose of usability factor for computerized
national and international standards. One discuss				systems is that it promotes an increase in user
about what makes a system usable or unusable				performance. Better performance means more
and why some systems function and some				gets done. One of the drawbacks of having a
malfunction. The discussion also contains what				system that creates and enhancement of
makes a system less or more effective.				performance is that it requires more skills of the
Materials and Methods				users. It is crucial that the right systems are put
The materials, which are used in this article, are				in place that suits the needs of their users. Being
the result of some evaluation and research that				that the health care system is a high-quality
the other researchers conducted, a study and a				environment, it is necessary that these systems
short look at an assignment that I have				work with at a high-quality level as well. It is clear
performed by a direct observation at the St. Olav				to see from (figure 1), that since implementing
hospital in Trondheim, Norway.				the new systems, user performance has
State of the art				increased, over the previous ways. After
In this section I am focusing mainly on usability,				researching about the usability factor, it is
functionality and efficiency of EHR systems				apparent that most users prefer the organized
according to some position papers, study and				method of data entry, filing and access abilities.
research result of some researchers.				With a more organized and secure method of
As we know an EHR system contains all medical				record keeping, client data is kept safe.
information of a patient.				Looking at the results of the research, it is quite
Walsh (2004) indicated, "the clinical usability of				clear that not all users were happy with the
electronic records systems is particularly relevant				computerized method. There were satisfied with
with the recent appointment of service providers				the way things more comfortable. Individual
to implement the National Integrated Care Record				understanding by employees can create usability
Service for the NHS as usability also affects				complications resulting in a disruption of
patient care."				performance. While the usability factor can seem
"Usability concerns whether an information				important, if a system is slow moving, it cannot
system is structured so that users can get an				work properly or as efficiently as it should. While a
answer to fit their purpose." (Zitner, 2006)				new form of data keeping using computers can
Edwards (2006) presented that" Electronic Medical				seem like the right move, it is not always the
Records (EMR) and computerized provider order				case. Performance is the key to implementing a
entries (CPOE) are recognized to improve quality				highly efficient functioning component of the job.
of care and patient safety. Results indicate users				It is not uncommon to find out that some of the
had positive perceptions of system ease of use				users are not completely satisfied with
after implementation. Post-implementation ratings				slow-moving systems that take up too much
were neutral or positive for most users."				time. While implementing a health care access
(Edwards, 2006)				system, we need to focus mainly on the user's
"The effects of introducing an EHR system and				needs. There are only two stakeholders generally
removing the paper-based electronic health record				the organization disseminating information and the
might depend on the size of the hospital, nature				users who can use information for their benefit.
of work at the department, functionality in the				On the other hand while implementing an EHR
EHR system introduced and preparedness, ability				system in a corporate environment the designer
and willingness of the hospital organization to				faces a tougher challenge. The usability of EHR to
adapt to the changes introduced" (Faxvaag, 2007				employees and users is one issue, the usability of
(Berg M, 2001))				products and a system as a whole can be
What makes a system more or less				increased by the implementation of it, which is a
user-friendly? One believes that system				broader second issue.
developers should pay attention to user's real				Three crucial functions may be performed due to
needs and demand. Thus they can design a				increase usability of an EHR system. First, it should
system according to their need. In such case a				help in getting feedback from the users, services
system can be satisfactory. The easiest way for				and send them to the developers, facilitate
making a system usable is to undertake true and				discussion among the software developers who
realistic testing by the future users of the system				design the system and users. This will give deeper
(usability testing). A system should be designed				insight to the product development team to
easy to use, functional, less complicated, eye				acknowledge consumers need. The second aspect
pleasing and user friendly.				is to facilitate the communication between
According to Faxvaag et al (2007), "an EHR				stakeholders and top brass of the
system provides immediate access to patient				organization,which will help in making decision
health record information by closing loops in				process democratically. Every stakeholder will feel
communication and reducing delays in obtaining				attached to the organization and as a result the
records from other providers. Faxvaag et al				longevity of organization will be ensured. A third
(2007) declared, "The-system was useful in				objective would be to preserve historical.
regard to professional learning. It mentioned that it				In conclusion one can imply that the usability of
was easy to call a chief physician who could look				EHR systems is dependent on the high
up the patient's case history in the EMR, or (in				functionality, efficiency and implementation. An
less urgent cases) send an electronic note to a				EHR should contain sufficient information of the
chief physician who would see the memo inhis				patients and clinical records. It should be secure,
work-list and could look up the case when he had				confidential and usable for many authorized users
time. Further, if someone needed a specialist to				to be able to view the records. Learning is
interpret an x-ray image and the physician in				another factor that we should not forget. The
question was at the operating theatre, the picture				newbies in healthcare system should be able to
could be displayed on screen in the theatre. So, in				learn from an EHR system. One should also have
the same way as the EMR-system was useful to				the ability to measure the health status so that a
support quick answers to external calls about				doctor may be able to help patient in most
inpatients."				effective way. A wrong implemented of an EHR
System developers and software programmers				system can lead to national catastrophes such as
usually conduct a usability testing to measure				what happened in Netherlands a few years ago.
usability.				One cannot deny the fact that the EHR systems
According to Møller et.al(2006)"usability				are more used than paper-based systems.
testing is a subset of the field of				Although there were occurred some mistakes in
human-computer interaction that involves applied				the past, but such systems help the authentic
psychology, computer science, and information				users to perform their jobs at the high level of
science.Although usability testing may take				quality, low cost and save their time.
different forms, it seeks to assess the				List of definitions
functionality of information technology such as				CPOE = Computerized provider order entry
clinical information systems, electronic				EHR = Electronic health record, repository of
documentation, and application software."				information regarding the health of a subject of
The system designer can continuously maintain a				care in computer processable form
high usability. Mølleret.al, (2006) has				EHR-system = computer application for obtaining,
conducted a research on how they could measure				archiving and distributing EHR's
the clinical usability of an EHR configured "by use				EMR= Electronic Medical Records
of participatory design with clinicians from a				References are indicated on my webpage.
neurological stroke unit in order to get input to the

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Evaluation of Usability and an Introduction of EHR Systems