Using a medical simulation center as an electronic health record usability laboratory

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This is a review of the article titled Using a medical simulation center as an electronic health record usability laboratory by Landman et al

Using a medical simulation center as an electronic health record usability laboratory.

Landman AB, Redden L, Neri P, Poole S, Horsky J, Raja AS, Pozner CN, Schiff G, Poon EG.

J Am Med Inform Assoc. 2014 May-Jun;21(3):558-63. doi: 10.1136/amiajnl-2013-002233. Epub 2013 Nov 18.


Electronic Health Records (EHRs) are becoming commonplace in hospitals and health care facilities and while for the most part they have brought improvements to healthcare delivery there have also been some Unintended Consequences. Some healthcare providers have expressed concerns that these systems are not easy to use and often add to their workload. Usability evaluations conducted before during and after implementation of EHRs can have an impact on the efficiency, safety and user satisfaction of these systems.

Medical simulation centers have long been used for training of medical staff and medical device vendors already use simulation centers as part of their product development process. To standardize clinical scenarios, simulate specific scenarios and collect usability metrics is difficult to do in a clinical environment. Indeed, some research groups have already created HIT usability laboratories for this purpose but these dedicated facilities require a great investment. [1]

The authors wished to investigate whether it would be possible to use a Medical simulation center as a HIT usability laboratory by integrating the EHR software.


As part of this investigation the EHR software was set up in a medical simulation center and configured to reflect and Emergency Department (ED) of a hospital to understand how ED doctors would use electronic documentation.


A multidisciplinary team with experience in medical informatics, medical simulation, medical education, emergency medicine and usability testing was assembled. A typical clinical scenario was created to study how ED clinicians would interact with the EHR system. A physician actor played the patient and the research staff helped run the scenario with one analyst facilitating the scenario, one taking notes, another playing the role of nurse interrupter and one setting up and monitoring the audio visual recording.

Physical space

The physical space of the medical simulation center was configured to represent a typical ED examination room. Workstations on wheels (WoWs) were used to enable participants to use and move computers at their discretion.

EHRs, simulation scenario

A custom-developed web-based ED EHR was integrated into the simulation center with collaboration of the IT department of the hospital to ensure the version being tested was the same as the current production system.

All participants were resident physicians with substantial ED EHR experience to ensure that their use of the system was being analysed and not their clinical knowledge or technology usage. Participants were given a short scripted scenario that required 20minutes to perform.

Data Collection

Morae Recorder (TechSmith US) was installed onto the WoWs to capture real time screen actions and interactions in real time. The Morae Observer software was installed on a workstation in the examination room to record key interactions with the EHR.


All the residents successfully completed the simulation scenario and each session produced multifaceted qualitative and quantitative data on the participant’s workflow.

Study team debriefings were held after each participant session. The data collected was compiled into cumulative lessons learned.


The authors did successfully integrate the ED EHR system with the medical simulation center and thereby did create an EHR usability testing laboratory.

They achieved this by detailed planning and strong partnerships with clinical educators, medical simulation experts and Information systems department.

They demonstrated that an organization could by working with the IT Department and the simulation center to create an EHR simulation environment.


This was a very interesting article that explored using existing medical simulation center infrastructure, that might be found in many teaching hospitals and integrating with EHR software via collaboration with technical and clinical experts to create a HIT system usability testing laboratory.

There are many usability testing techniques and methods but a simulation laboratory might provide insights or richness of observations in near real settings not possible by other means. The findings of this study indicate the possibility of using existing infrastructure to achieve a usability laboratory thus reducing the cost of investing in the development of a new laboratory environment.

Related Articles


  1. Haugen H. Advantages of simulation training.How to improve EMR adoption.