Heuristic evaluation of eNote: an electronic notes system

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eNote is an electronic health record system that uses a combination of document templates and natural language processing (NLP) for use by physicians to make semi-structured clinical notes. Bright, Bakken, and Johnson used a heuristic evaluation which is a type of usability inspection method. This method is inexpensive, easy to use, and provides quick feedback. [1]


Bright et al. asked five heuristic evaluation experts to fill out a clinician’s eNote and then answer 118 questions from the Nielsen’s usability heuristics concerning the eNote. The experts either answered yes or no to these questions.


For each evaluation a score was derived by subtracting the negative answers from the total number of questions. A higher number resulted in a higher usability. The results include: higher numbers for consistency with standards and recognition rather than recall. Lower numbered results include: help and documentation, aesthetic and minimalist design, error prevention, helping users recognize, diagnosis, recover from errors, and flexibility and efficiency of use.


This study led to the authors to consider developing a “better, user-centered interface” where eNote can be improved to better suite physicians’ needs for clinical notes.


This is an interesting study because it is a small study that only considers five subjects and the usability of eNotes. However, it does make some important questions about how clinical notes in eNotes can be more user friendly and more useful.

Additional comments

I agree that this is an interesting study and an important area for research. Benefits of electronic notes include legibility and easy dissemination allowing for multiple providers to take part in care, however electronic notes creates new issues and problems. Cut and paste errors can happen easily, too much data incorporated into the notes makes it difficult for the reader to extract valuable information. Therefore it is very important to develop a system of evaluating quality of physicians notes and as well as develop usable notes. [2]

Related Article Reviews

Open source EMR software: Profiling, insights, and hands-on analysis

The impact of electronic health records on healthcare quality: a systematic review and meta-analysis

A user-centered framework for designing health care interfaces


  1. Bright, T. J., Bakken, S., & Johnson, S. B. (2006). Heuristic Evaluation of eNote: an Electronic Notes System. AMIA Annual Symposium Proceedings, 2006, 864. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839434/
  2. Stetson, P. D., Morrison, F. P., Bakken, S., Johnson, S. B., & eNote Research Team. (2008). Preliminary Development of the Physician Documentation Quality Instrument. Journal of the American Medical Informatics Association : JAMIA, 15(4), 534–541. http://doi.org/10.1197/jamia.M2404