[ad_1]
Abstract
Objective The aim of this study was to assess how different groups of health professionals evaluated the usability of a new electronic health record (EHR) and to investigate the association between the usability and burnout, insomnia and turnover intention.
Methods This cross-sectional study included 1424 health professionals who worked at a Norwegian University Hospital. The usability was measured with the System Usability Scale (SUS) 6 months after the previous electronic record was replaced with a more comprehensive, sector-wide, patient-centred EHR in 2022.
Results The median SUS score was 25 (IQR 12.5–37.5) out of 100 and ranged from 15 (IQR 7.5–25.0) among medical doctors to 40 (IQR 27.6–55.0) among laboratory technicians. Nurses reported a score of 25 (IQR 12.5–40.0). In clinical contexts, the median SUS score ranged from 15 (IQR 10.0–30.0) within radiology to 27.5 (IQR 15.0–42.5) within internal medicine, whereas laboratory medicine reported a score of 37.5 (IQR 27.5–55.0). In multivariable analyses using health professionals in the highest quarter of the SUS as the reference, those in the lowest quarter were more likely to report burnout (OR 3.05, 95% CI 1.86 to 5.00), insomnia (OR 1.72, 95% CI 1.18 to 2.50) and turnover intention (OR 2.35, 95% CI 1.53 to 3.64).
Conclusion Most health professionals across all occupational groups and clinical contexts reported low usability of a new EHR 6 months after go-live. Those who reported the lowest usability were more likely to report burnout, insomnia and turnover intention.
Introduction
Over the last decade, vast investments in health information technology, such as electronic health records (EHRs), have been made globally.1–3 These investments have been built on the assumption that EHRs will improve patient care across healthcare settings.2 4 To support and facilitate clinical work, health professionals depend on the usability of an EHR to enter, view and extract health information quickly and accurately. To reach an acceptable usability level in hospital, it is important to have a well-designed EHR architecture.5–7 Usability, which is defined as the extent to which technology can be used to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use, has therefore emerged as a critical issue in healthcare.8
Replacing a hospital facility-centred electronic patient record (EPR) with a more comprehensive, sector-wide, patient-centred EHR that interacts with other hospitals, municipalities and primary care entails a comprehensive sociotechnical change. This transforms clinical work tasks, workflows and quality of patient care.2 5 9 Such transition is particularly challenging because of the complexity of medical data, security and collaboration across healthcare settings.10 11 Previous studies have reported overall poor EHR usability in hospitals post implementation.12–16 However, these studies have primarily focused on medical doctors and nurses12 13 15 or one clinical context (eg, emergency medicine or mental health setting).14 16 Since hospitals comprise different types of health professionals who are exposed to different work demands and specific work tasks while using the EHR, it is important to evaluate the usability across all occupational groups and clinical contexts. This knowledge will be relevant for hospitals planning to implement comprehensive, sector-wide, patient-centred EHRs.
Health professionals who report poor EHR usability are more likely to report job dissatisfaction,17 turnover intention17 and burnout.12 13 15 A plausible explanation is that poor usability leads to increased cognitive workload by introducing new tasks and more complex reporting.18 However, there is a lack of studies that address the link between these variables after go-live of a new EHR. Moreover, an unexplored factor in the context of usability is sleep. It is well documented that cognitive and emotional work demands are linked to insomnia symptoms,19 and that insomnia among health professionals is associated with reduced work performance, sick leave and accidents.20 Nevertheless, no study has assessed whether insomnia is more prevalent among health professionals who report low EHR usability.
The aim of this cross-sectional study was twofold. First, to describe how health professionals within different occupational groups and clinical contexts evaluate the usability of a sector-wide, patient-centred EHR 6 months after it replaced a hospital facility-centred EPR. Second, to examine the association between the usability and burnout, insomnia and turnover intention.
Discussion
This cross-sectional study showed that health professionals across all occupational groups and clinical contexts in hospital reported low usability of a sector-wide, patient-centred EHR 6 months after go-live. The overall median SUS score was 25 out of 100, indicating a not acceptable usability level.25 Health professionals who reported the lowest usability were more likely to report burnout, insomnia and turnover intention.
Usability among different occupational groups and clinical contexts
The median SUS score in the current study was very low compared with previous studies.12 13 16 These studies have primarily described usability among nurses and medical doctors12 13 within one clinical context16 or without indication of time period for implementation.12 13 Some studies using the same software supplier as in the current study have shown poor usability in the years after go-live, with some variability across different health professionals.3 16 A study that analysed the implementation of EHRs in Denmark and Finland found extensive user dissatisfaction in both countries several years after go-live.3 In Finland, they scored the usability (eg, logical functions, understandable terminology, easy access to patient information) much lower after implementation of the new system, and medical doctors were less satisfied than nurses and social workers.3 Our study builds on these previous evaluations of usability by studying the usability among all occupational groups and clinical contexts in a hospital 6 months after a patient-centred EHR replaced a facility-centred EPR. Despite the overall low usability in the current study, we found some statistically significant differences between occupational groups and clinical contexts. Specifically, medical doctors reported the lowest usability, and laboratory technicians reported the highest. Some variability is expected considering that different groups of health professionals rely differently on the EHR as a tool to perform their clinical work tasks. The heterogeneity of patients and clinical work in different clinical contexts means that there is a large variety in documentation time, complexity of medical data, acuteness of work and consequences of mistakes. The variety of work tasks and responsibility for patient treatment and medication prescriptions could explain why medical doctors reported the lowest usability. In a sensitivity analysis where we restricted our analysis to medical doctors, we found that medical doctors in oncology and psychiatry reported lower usability than those within internal medicine and laboratory medicine. However, these results should be interpreted with caution due to low participation in some of the clinical contexts. Moreover, our findings showing the highest usability among laboratory technicians could be explained by more standardised work tasks and the fact that they had been using the system for a longer period due to an earlier point of go-live.
Notably, the present study evaluated a comprehensive patient-centred EHR that replaced a hospital facility-centred EPR. Compared with the old EPR, the new EHR has a more detailed interface and requires health professionals to perform more standardised work to deliver semantic interoperable health data to support clinical decision-making and information exchange across primary, secondary and tertiary care.2 11 The overall low usability in this study could therefore be related to poor adaptation to the hospital work processes. For instance, it is important that the design of the EHR fits the health professional’s specific needs and that it has been properly tested regarding learnability, efficiency in use and risk of errors.6 Previous research highlights the importance of adequate training and real-time support, especially if work is planned to be performed differently.30 However, after 6 months with full operation and frequent use of the system, most health professionals should have gained experience using the system. This suggests that the system has a hard-to-learn interface that does not support specified users in a specified context of use.6
Usability and its association with burnout, insomnia and turnover intention
Despite the overall low SUS score, we found that burnout, insomnia and turnover intention were more prevalent among health professionals who reported the lowest usability. Our results are in line with previous cross-sectional studies showing that low usability is associated with higher prevalence of burnout.12 13 15 The current study expands on these findings by showing that the prevalence of all the interdependent dimensions of burnout increased with decreasing usability scores. However, it should be noted that the prevalence of the dimension that captures enthusiasm, aversion and cynicism at work was especially high among those who reported the lowest usability. Thus, this finding, together with our finding that turnover intention is more prevalent among those with low usability, suggests that usability is related to employees’ motivation to work and intentions to stay in their job.
We are not aware of any previous study that has investigated the association between usability and insomnia symptoms. Since cognitive intrusion caused by stressful work exposure may contribute to poor sleep quality,19 it is plausible that a high cognitive workload due to low usability leads to insomnia symptoms, possibly due to worrying thoughts (eg, fear of mistakes, unfinished work). Indeed, it is possible that health professionals who suffer from insomnia or burnout have reduced abilities to learn and adapt to digital transformation.
Implications and future directions
Our findings showing very low usability after 6 months with full operation and use of extra resources are relevant for hospitals that are planning the implementation of comprehensive, sector-wide, patient-centred EHRs. In times when the healthcare system is under pressure, it is important that EHRs are designed to support clinical work for the health professionals. An EHR that is intuitive and easy to use will maintain daily operations in all phases of the EHR transition and facilitate quick onboarding of new staff. Policymakers and stakeholders must ensure that the usability architecture is acceptable before implementation and continuously test the usability after go-live to further optimise the system. Future research should explore the role of specific usability issues (eg, ease of use, information quality, collaboration) and focus on usability testing across different occupations within different clinical contexts. Moreover, additional research is needed to determine causal relations between usability and health outcomes in health professionals.
Strengths and limitations
The strengths of this study include the evaluation of the usability across several occupational groups and clinical contexts and the use of standardised questionnaires. Some limitations should be considered when interpreting the results. First, the SUS questionnaire is designed to evaluate the usability of specific computerised tasks and not the overall usability of an EHR system. Second, there was a lot of debate in the media prior to this survey, and we cannot exclude the possibility that workers with negative attitudes towards the new EHR were more likely to participate. However, it is also possible that the workers with more positive attitudes towards the new EHR and with sufficient time were more likely to participate, or that workers preoccupied with high workload due to the EHR did not have the time or desire to participate. Third, when we examined the associations between usability and burnout, insomnia and turnover intention, we could not stratify our analyses by occupations or clinical contexts due to the sample size. Finally, our cross-sectional study was not designed to investigate any causal relations between the usability and burnout, insomnia and turnover intention.
Conclusions
In a university hospital, we found very low usability across all occupational groups and clinical contexts 6 months after a sector-wide, patient-centred EHR replaced a hospital facility-centred EPR. Health professionals who reported the lowest usability were more likely to report burnout, insomnia and turnover intention. Our study suggests that it is important to ensure acceptable usability to support clinical work for the health professionals.
[ad_2]
Source link
