Usability challenges continue to affect health information technology (HIT), according to a viewpoint article by Raj M. Ratwani, PhD, of the MedStar Health National Center for Human Factors in Healthcare, Georgetown University School of Medicine, in Washington, DC, and colleagues, published in JAMA.

Most US hospitals and ambulatory clinicians have adopted electronic health records (EHR), and this technology has provided some important benefits, including easier access to patient information and easier ordering of medications, laboratory tests, and diagnostic tests. Nonetheless, usability of the EHR technology remains less than optimal. Poor EHR usability can lead to physicians spending too much time trying to input or access information and, in some cases, even patient harm.

Efforts to improve HIT usability have had a modest effect at best. Although the Office of the National Coordinator for Health Information Technology requires a design and development process promoting usability and requires usability testing, not all vendors comply.

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Dr Ratwani and colleagues offered 5 key suggestions to improve the efficiency and effectiveness of these programs, as well as patient and physician satisfaction with them.

The first is to create a national database of usability and safety issues, much like the US Food and Drug Administration Manufacturer and User Facility Device Experience database for medical devices. The database should permit sharing of safety-related software information between vendors, healthcare organizations, and physicians.

The second suggestion is to establish basic design standards that incorporate evidence-based principles on optimal computer interface design. Vendors and some policymakers have been reluctant to establish HIT design standards, as they fear stifling innovation. Ratwani, et al believe that the Office of the National Coordinator for Health Information Technology should lead such an effort.

The third suggestion is to address unintended harms. Policy makers should examine “hold harmless” clauses that protect vendors from liability to ensure that they are held accountable for design flaws that result in harm.

The viewpoint authors’ fourth point is that some federal documentation requirements increase the busy work physicians face, and unnecessary requirements should be eliminated.

Their final suggestion is the development of standard usability and safety measures so that progress can be tracked and the market can react.

Most important, perhaps, the Dr Ratwani and colleagues argued that improving HIT usability requires the engagement of all groups: vendors, researchers, policy makers, healthcare organizations, physicians, and patients.


Ratwani RM, Reider J, Singh H. A decade of health information technology usability challenges and the path forward [published online February 4, 2019]. JAMA. doi: 10.1001/jama.2019.0161