scholarly journals Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis

10.2196/23382 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e23382
Author(s):  
Edward R Melnick ◽  
Elizabeth Harry ◽  
Christine A Sinsky ◽  
Liselotte N Dyrbye ◽  
Hanhan Wang ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Mediation Analysis ◽  
National Level ◽  
Maslach Burnout Inventory ◽  
Medical Decision ◽  
Health Record ◽  
Professional Burnout ◽  
Task Load ◽  
System Usability Scale ◽  
Electronic Health

Background Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task load. Objective This study aimed to determine the relationship between physician-perceived EHR usability and workload by specialty and evaluate for associations with professional burnout. Methods A secondary analysis of a cross-sectional survey of US physicians from all specialties was conducted from October 2017 to March 2018. Among the 1250 physicians invited to respond to the subsurvey analyzed here, 848 (67.8%) completed it. EHR usability was assessed with the System Usability Scale (SUS; range: 0-100). Provider task load (PTL) was assessed using the mental demand, physical demand, temporal demand, and effort required subscales of the National Aeronautics and Space Administration Task Load Index (range: 0-400). Burnout was measured using the Maslach Burnout Inventory. Results The mean scores were 46.1 (SD 22.1) for SUS and 262.5 (SD 71.7) for PTL. On multivariable analysis adjusting for age, gender, relationship status, medical specialty, practice setting, hours worked per week, and number of nights on call per week, physician-rated EHR usability was associated with PTL, with each 1-point increase in SUS score (indicating more favorable) associated with a 0.57-point decrease in PTL score (P<.001). On mediation analysis, higher SUS score was associated with lower PTL score, which was associated with lower odds of burnout. Conclusions A strong association was observed between EHR usability and workload among US physicians, with more favorable usability associated with less workload. Both outcomes were associated with the odds of burnout, with task load acting as a mediator between EHR usability and burnout. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision making and patient communication.

scholarly journals Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis (Preprint)

2020 ◽  
Author(s):  
Edward R Melnick ◽  
Elizabeth Harry ◽  
Christine A Sinsky ◽  
Liselotte N Dyrbye ◽  
Hanhan Wang ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Mediation Analysis ◽  
National Level ◽  
Maslach Burnout Inventory ◽  
Medical Decision ◽  
Health Record ◽  
Professional Burnout ◽  
Task Load ◽  
System Usability Scale ◽  
Electronic Health

BACKGROUND Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task load. OBJECTIVE This study aimed to determine the relationship between physician-perceived EHR usability and workload by specialty and evaluate for associations with professional burnout. METHODS A secondary analysis of a cross-sectional survey of US physicians from all specialties was conducted from October 2017 to March 2018. Among the 1250 physicians invited to respond to the subsurvey analyzed here, 848 (67.8%) completed it. EHR usability was assessed with the System Usability Scale (SUS; range: 0-100). Provider task load (PTL) was assessed using the mental demand, physical demand, temporal demand, and effort required subscales of the National Aeronautics and Space Administration Task Load Index (range: 0-400). Burnout was measured using the Maslach Burnout Inventory. RESULTS The mean scores were 46.1 (SD 22.1) for SUS and 262.5 (SD 71.7) for PTL. On multivariable analysis adjusting for age, gender, relationship status, medical specialty, practice setting, hours worked per week, and number of nights on call per week, physician-rated EHR usability was associated with PTL, with each 1-point increase in SUS score (indicating more favorable) associated with a 0.57-point decrease in PTL score (<i>P</i>&lt;.001). On mediation analysis, higher SUS score was associated with lower PTL score, which was associated with lower odds of burnout. CONCLUSIONS A strong association was observed between EHR usability and workload among US physicians, with more favorable usability associated with less workload. Both outcomes were associated with the odds of burnout, with task load acting as a mediator between EHR usability and burnout. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision making and patient communication.

Assessing HIPAA Compliance of Open Source Electronic Health Record Applications

2021 ◽  
Vol 15 (2) ◽  
pp. 181-195
Author(s):  
Hossain Shahriar ◽  
Hisham M. Haddad ◽  
Maryam Farhadi
Keyword(s):  
Electronic Health Record ◽  
Open Source ◽  
Medical Decision ◽  
Patient Treatment ◽  
Health Record ◽  
Technical Requirements ◽  
Patient Health ◽  
Treatment Plans ◽  
Electronic Health ◽  
Quality In Healthcare

Electronic health record (EHR) applications are digital versions of paper-based patient health information. EHR applications are increasingly being adopted in many countries. They have resulted in improved quality in healthcare, convenient access to histories of patient medication and clinic visits, easier follow up of patient treatment plans, and precise medical decision-making process. The goal of this paper is to identify HIPAA technical requirements, evaluate two open source EHR applications (OpenEMR and OpenClinic) for security vulnerabilities using two open-source scanner tools (RIPS and PHP VulnHunter), and map the identified vulnerabilities to HIPAA technical requirements.

scholarly journals How well is the electronic health record supporting the clinical tasks of hospital physicians? A survey of physicians at three Norwegian hospitals

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Roger Schopf ◽  
Bente Nedrebø ◽  
Karl Ove Hufthammer ◽  
Inderjit Kaur Daphu ◽  
Hallvard Lærum
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Electronic Health Record System ◽  
System Stability ◽  
Medical Decision ◽  
Health Record ◽  
Clinical Workflow ◽  
Online Questionnaire ◽  
Record System ◽  
Electronic Health

Abstract Background The electronic health record is expected to improve the quality and efficiency of health care. Many novel functionalities have been introduced in order to improve medical decision making and communication between health care personnel. There is however limited evidence on whether these new functionalities are useful. The aim of our study was to investigate how well the electronic health record system supports physicians in performing basic clinical tasks. Methods Physicians of three prominent Norwegian hospitals participated in the survey. They were asked, in an online questionnaire, how well the hospital’s electronic health record system DIPS supported 49 clinical tasks as well as how satisfied they were with the system in general, including the technical performance. Two hundred and eight of 402 physicians (52%) submitted a completely answered questionnaire. Results Seventy-two percent of the physicians had their work interrupted or delayed because the electronic health record hangs or crashes at least once a week, while 22% had experienced this problem daily. Fifty-three percent of the physicians indicated that the electronic health record is cumbersome to use and adds to their workload. The majority of physicians were satisfied with managing tests, e.g., requesting laboratory tests, reading test results and managing radiological investigations and electrocardiograms. Physicians were less satisfied with managing referrals. There was high satisfaction with some of the decision support functionalities available for prescribing drugs. This includes drug interaction alerts and drug allergy warnings, which are displayed automatically. However, physicians were less satisfied with other aspects of prescribing drugs, including getting an overview of the ongoing drug therapy. Conclusions In the survey physicians asked for improvements of certain electronic health record functionalities like medication, clinical workflow support including planning and better overviews. In addition, there is apparently a need to focus on system stability, number of logins, reliability and better instructions on available electronic health record features. Considerable development is needed in current electronic health record systems to improve usefulness and satisfaction.

scholarly journals Development and evaluation of a novel user interface for reviewing clinical microbiology results

2018 ◽  
Vol 25 (8) ◽  
pp. 1064-1068 ◽  
Author(s):  
Adam Wright ◽  
Pamela M Neri ◽  
Skye Aaron ◽  
Thu-Trang T Hickman ◽  
Francine L Maloney ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Clinical Microbiology ◽  
Block Design ◽  
Health Record ◽  
Time On Task ◽  
Microbiology Laboratory ◽  
System Usability Scale ◽  
System Usability ◽  
Laboratory Results ◽  
Electronic Health

Abstract Background Microbiology laboratory results are complex and cumbersome to review. We sought to develop a new review tool to improve the ease and accuracy of microbiology results review. Methods We observed and informally interviewed clinicians to determine areas in which existing microbiology review tools were lacking. We developed a new tool that reorganizes microbiology results by time and organism. We conducted a scenario-based usability evaluation to compare the new tool to existing legacy tools, using a balanced block design. Results The average time-on-task decreased from 45.3 min for the legacy tools to 27.1 min for the new tool (P &lt; .0001). Total errors decreased from 41 with the legacy tools to 19 with the new tool (P = .0068). The average Single Ease Question score was 5.65 (out of 7) for the new tool, compared to 3.78 for the legacy tools (P &lt; .0001). The new tool scored 88 (“Excellent”) on the System Usability Scale. Conclusions The new tool substantially improved efficiency, accuracy, and usability. It was subsequently integrated into the electronic health record and rolled out system-wide. This project provides an example of how clinical and informatics teams can innovative alongside a commercial Electronic Health Record (EHR).

scholarly journals User Evaluation of the Swedish Patient Accessible Electronic Health Record: System Usability Scale (Preprint)

2020 ◽  
Author(s):  
Maria Hägglund ◽  
Isabella Scandurra
Keyword(s):  
Electronic Health Record ◽  
Ease Of Use ◽  
Survey Study ◽  
Health Record ◽  
Patient Portal ◽  
Data Set ◽  
System Usability Scale ◽  
System Usability ◽  
National Patient ◽  
Electronic Health

BACKGROUND Transparency is increasingly called for in health care, especially, when it comes to patients’ access to their electronic health records. In Sweden, the e-service Journalen is a national patient accessible electronic health record (PAEHR), accessible online via the national patient portal. User characteristics and perceived benefits of using a PAEHR influence behavioral intention for use and adoption, but poor usability that increases the effort expectancy can have a negative impact. It is, therefore, of interest to explore how users of the PAEHR Journalen perceive its usability and usefulness. OBJECTIVE The aim of this study was to explore how the users of the Swedish PAEHR experience the usability of the system and to identify differences in these experiences based on the level of transparency of the region. METHODS A survey study was conducted to elicit opinions and experiences of patients using Journalen. The data were collected from June to October 2016. The questionnaire included questions regarding the usability of the system from the System Usability Scale (SUS). The SUS analysis was the focus of this paper. Analysis was performed on different levels: nationally looking at the whole data set and breaking it down by focusing on 2 different regions to explore differences in experienced usability based on the level of transparency. RESULTS During the survey period, 423,141 users logged into Journalen, of which 2587 unique users completed the survey (response rate 0.61%). The total mean score for all respondents to the SUS items was 79.81 (SD 14.25), which corresponds to a system with good usability. To further explore whether the level of transparency in a region would affect the user’s experience of the usability of the system, we analyzed the 2 regions with the most respondents: Region Uppsala (the first to launch, with a high level of transparency), and Region Skåne (an early implementer, with a low level of transparency at the time of the survey). Of the participants who responded to at least 1 SUS statement, 520 stated that they had received care in Region Skåne, whereas 331 participants had received care in Region Uppsala. Uppsala’s mean SUS score was 80.71 (SD 13.41), compared with Skåne’s mean of 79.37 (SD 13.78). CONCLUSIONS The Swedish national PAEHR Journalen has a reasonably good usability (mean SUS score 79.81, SD 14.25); however, further research into more specific usability areas are needed to ensure usefulness and ease of use in the future. A somewhat higher SUS score for the region with high transparency compared with the region with low transparency could indicate a relationship between the perceived usability of a PAEHR and the level of transparency offered, but further research on the relationship between transparency and usability is required.

Compliance of Electronic Health Record Applications With HIPAA Security and Privacy Requirements

2018 ◽  
pp. 199-213 ◽  
Author(s):  
Maryam Farhadi ◽  
Hisham M. Haddad ◽  
Hossain Shahriar
Keyword(s):  
Electronic Health Record ◽  
Health Information ◽  
Security And Privacy ◽  
Medical Decision ◽  
Patient Treatment ◽  
Health Record ◽  
Privacy Requirements ◽  
Improper Use ◽  
Electronic Health ◽  
Quality In Healthcare

Electronic health record (EHR) applications are digital versions of paper-based patients health information. EHR applications are increasingly being adopted in many countries. They have resulted in improved quality in healthcare, convenient access to histories of patient medication and clinic visits, easier follow up of patient treatment plans, and precise medical decision-making process by doctors. EHR applications are guided by measures of the Health Insurance Portability and Accountability Act (HIPAA) to ensure confidentiality, integrity, and availability. However, there have been reported breaches of protected health identifier (PHI) data stored by EHR applications. In many reported breaches, improper use of EHRs has resulted in disclosure of patient's protected health information. The goal of this chapter is to (1) provide an overview of HIPAA security and privacy requirements; (2) summarize recent literature works related to complying with HIPAA security and privacy requirements; (3) map some of the existing vulnerabilities with HIPAA security rules.

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