Study highlights prevalence of poor technology in emergency care

UK Emergency Department survey shows poor usability for major EHRs, with NHS CCIO saying ‘too little has changed’ in 15 years.
By Dillan Yogendra
11:13 AM

Credit: Photo by Cristian Casanelles/ Getty Images

Emergency doctors in the UK have said many electronic health records (EHRs) in use are close to being unacceptable, and this is likely to be having a negative impact on patient care.

A national survey of more than 1,500 members and fellows of the Royal College of Emergency Medicine ranked the usability of the major EHRs in use across the UK. All fell short of internationally recognised usability standards.

It led NHS CCIO Simon Eccles to remark that 'too little has changed' from research done 15 years ago that highlighted the poor usability of electronic records. "Good usability leads to better safety," he said on Twitter. Usability "is really important for basic safety, to not waste clinical time, and to enable best practice."

Fifteen systems were ranked against the System Usability Scale, which is recognised as an effective international measure of system usability. The median score for all systems was 53, compared to an industry average of 68. Products with a usability score lower than 50 are judged to be unacceptable, and several fell below this figure including Atos and DXC.


The study, recently published in the BMJ highlights how systems with poor usability are a threat to patient safety, are inefficient, and contribute to burnout and an unfulfilling working life. Good systems may actively prevent patient harm by helping to ensure clinical staff correctly follow the right care processes.

Study co-author Ben Bloom, Royal London Hospital, highlighted how poor usability has been cited as one of the major barriers to realising the benefits of digital health records.

He told Healthcare IT News: "Usability directly impacts how staff work within the NHS. Time spent entering data is not spent directly caring for patients. Systems with good usability, particularly those into which users have had a say in the design, lead to improved work fulfilment. In contrast, poorly usable systems contribute to low morale and staff burnout."


The situation is particularly relevant to emergency departments, where there is said to be a high turnover of doctors. Systems need to be as intuitive as possible if they are to be useful.

Bloom recommended that providers collaborate and gathered data on usability. This would present a true, united and consistent account of where improved systems would lead to improved processes, and therefore improved healthcare delivery.


Paul Volkaerts, CEO of Nervecentre, whose system was ranked top for usability with a median score of 65, supported such closer scrutiny.

"Since the advent of EHR systems, 'clinician usability' has been the evasive holy grail," he said. "Poor usability leads to poor user adoption, takes up clinical time, and can directly impact patient safety and clinical outcomes.

"Regular surveys of this nature would help the industry and system buyers gain an informed perspective on those suppliers that are investing in usability, versus those that are not. We have taken strong steps to ensure our mobile EPR is the most user-friendly in the market since this research was undertaken, and will continue to do so in close collaboration with frontline staff."

The study also recommended that further research should be undertaken with users to understand what characteristics of an EHR system make it most usable.


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