Evaluating the Usability of a Free Electronic Health Record for Training

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Training is a key part of Electronic health records (EHRs) adoption, as the US healthcare industry is moving towards complete digitization. However, with the emergence and existence of a multitude of EHR vendors, uniform training is difficult to achieve due to the differences in EHR usability. “Usability is defined by the US National Institute of Standards and Technology (NIST) as “the effectiveness, efficiency and satisfaction with which the intended users can achieve their tasks in the intended context of product use.” [1] Effectiveness refers to ability to complete tasks without errors, efficiency is the time taken to complete a task, and satisfaction refers to the “subjective evaluation using tools such as surveys.” [1]

This article evaluates the usability of a web-based EHR (Practice Fusion) for training health informatics and health information management students using qualitative-quantitative analysis.


In the summer semester of 2011 and the spring and summer semester of 2012, a usability survey and time-motion study was conducted on student from the University of West Florida and Lake-Sumter Community College.

EHR satisfaction was measured using the Questionnaire for User Interaction Satisfaction (QUIS) survey (version 7.0) based on 6 categories, namely:

  • User Demographics (6 Questions)
  • Overall Reaction Ratings (6 Questions)
  • Screen Design and Layout (4 Questions)
  • Terminology and System Information (6 Questions)
  • Learning (4 Questions)
  • System Capabilities (5 Questions)

Using a Likert scale ranging from 1 (lowest) to 9 (highest), satisfaction ratings were recorded.

Time-motion study (time on task and error rates), was conducted to evaluate the ability of participants to complete routine EHR tasks by monitoring time-stamp of the length of time it takes to complete a task and error rates committed by omission and commission.

Using descriptive statistics, the QUIS survey data and time-motion study were evaluated.


A total of 152 students participated in this study, of which, 44 completed the QUIS survey and 23 completed the survey and the time-motion study. The average time it took a majority of students to complete all tasks was 19 minutes and varied tasks between 11 to 36 minutes, with clinicians completing tasks faster than non-clinicians (p < .0025). In addition, the average number of errors per student for nurse tasks = 0.83, physician tasks = 1.13, and total average errors = 1.88. No significant correlation was noted with total time to complete the time-motion study and overall satisfaction.


Based on this study, students found the computer interface of Practice Fusion user friendly and required minimum training, this establishing that web-based EHR training had high usability on the basis of effectiveness (low overall error rate with an average total error of 1.9 per student), efficiency (clinicians had shorter task completion times), and satisfaction (no major correlation between EHR satisfaction and task completion time).


Usability is an important part of EHR training. Through this study, it was determined that efficient, effective, and high satisfaction was associated with EHR usability for informatics and HIM student training. With improvements in design and usability testing, easier adoption of user-centered EHR can be facilitated, which can lead to improvements in clinician productivity and patient safety.


  • User Responses to Questionnaire for User Interaction Satisfaction (QUIS) and Non-QUIS Questions and Confidence Intervals (CIs) [2]
  • Time-Motion Scores (Minutes) and Confidence Intervals (CIs) [3]
  • Error Rates Associated with the Time-Motion Study [4]
  • Comparisons between Demographics, Overall Satisfaction, and Time-Motion Data [5]

My Comments

I found this article interesting because it evaluates usability in relation to efficiency (productivity) and effectiveness (patient safety) and satisfaction. With the many EHRs that exist right now, it is hard to train students because they all differ, which can lead to frustration and reluctance to adopt EHRs. Another thing I found interesting, was that nursing tasks were easier to complete than other tasks and that demographics was not significantly related to overall satisfaction. Also, I have used the EHR used in this study (Practice Fusion) and I find it very user friendly, so I’m not surprised it was ranked 4th in a survey of family medicine physician. I don’t really have any critiques of this article.

Related Articles

Simulated Electronic Health Record (Sim-EHR) Curriculum: Teaching EHR Skills and Use of the EHR for Disease Management and Prevention

A Novel Approach to Supporting Relationship-Centered Care Through Electronic Health Record Ergonomic Training in Preclerkship Medical Education

Nurses Readiness and Electronic Health Records

Advanced Proficiency EHR Training: Effect on Physicians’ EHR Efficiency, EHR Satisfaction and Job Satisfaction

Training providers: beyond the basics of electronic health records

Usability testing of mobile ICT for clinical settings: Methodological and practical challenges

EHR Usability Testing Service The Office of the National Coordinator for Health Information Technology (ONC)


  1. 1.0 1.1 Hoyt, R., Adler, K., Ziesemer, B., & Palombo, G. (2013). Evaluating the Usability of a Free Electronic Health Record for Training. Perspectives in health information management/AHIMA, American Health Information Management Association, 10(Spring). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692322/
  2. User Responses to Questionnaire for User Interaction Satisfaction (QUIS) and Non-QUIS Questions and Confidence Intervals (CIs). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692322/table/T1/
  3. Time-Motion Scores (Minutes) and Confidence Intervals (CIs). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692322/table/T2/
  4. Error Rates Associated with the Time-Motion Study. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692322/table/T3/
  5. Comparisons between Demographics, Overall Satisfaction, and Time-Motion Datahttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692322/table/T4/