Nurses give EHR usability an 'F' in new study

The report also finds that poor electronic health record user-experience is associated with nurse burnout.
By Kat Jercich
02:07 PM

(Photo by FG Trade/Getty Images)

A study published this week in the Journal of the American Medical Informatics Association found that more favorable electronic health record usability scores are associated with lower odds of burnout – and those usability scores have tanked.   

Researchers found that among 1,285 nurses who responded to a November 2017 survey about usability and burnout the mean nurse-rated EHR usability score was 57.6.   

The research team categorized this with a grade of "F."  

"To our knowledge, this is the first study to measure nurses’ perceptions of EHR-usability nationally using a standardized metric," wrote the researchers.  


EHR usability has been found to be a source of frustration for physicians, but less is known about perceived usability among nurses. The study team – comprising researchers from the Yale School of Medicine, the Mayo Clinic, the University of Virginia School of Nursing, the American Nurses Association and the Stanford School of Medicine – sought to change that.

Researchers noted that nursing is the healthcare profession with the largest workforce, meaning high burnout rates are "significant and troubling."    

"Indeed, burnout has been associated with lower job performance among nurses, lower patient satisfaction, leaving patient care tasks undone or incomplete, and poorer patient outcomes, including higher mortality rates," in addition to lower job satisfaction and higher rates of attrition.  

To measure perceived usability, researchers used the industry-standard System Usability Scale and asked respondents to an online survey to answer ten questions.   

The mean SUS score among nurses was 57.6 – higher than the mean score among physicians, but still considered a failing grade. (By contrast, the mean vendor-reported EHR SUS score was 75.0.)

Researchers measured professional burnout using the Maslach Burnout Inventory, which assesses professional burnout regarding emotional exhaustion, personal accomplishment and depersonalization.  

Overall, 42% of the respondents were determined to be burned out.   

Notably, those without burnout had a 3.5 higher score on the SUS. In other words, EHR usability was strongly associated with burnout in this sample of U.S. nurses.  

"The low marginal acceptability of nursing EHR usability scores reported here emphasizes the importance of improving EHR usability from the nursing perspective," wrote researchers.   


Although burnout is undoubtedly an issue for clinicians throughout the country (especially during the pandemic), the cause remains somewhat murky.   

Previous reports have found that EHRs aren't a major factor in nurse burnout – although some practices aimed at improving usability have been found to reduce it.  

Indeed, Healthcare IT News reporting finds that technology can both hurt and help with burnout issues.

"Unfortunately, IT has been cited multiple times as a reason for nurse burnout," said Suong Nguyen, RN, a critical care nurse at the New Jersey system Virtua Health, to HITN's Bill Siwicki in November.  


Given the increasing use and dependence on technology for care delivery and the fact that nurses are the largest healthcare professional workforce, it is troubling that 98% of licensed nurses report never having been included in hospital technology design or decisions," read the study.  

"To design and implement technology that better meets nurses’ needs, it will be necessary to include input from and amplify the voice of nurses to better understand how technology can better meet their needs," it continued.


Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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