DOI: 10.5061/dryad.7h44j0zsq
title: Usability of electronic health record systems in UK emergency departments

description: Background The large volume of patients, rapid staff turnover and high
 work pressure means that the usability of all systems within the Emergency
 Department (ED) is important. The transition to electronic health records
 (EHRs) has brought many benefits to emergency care but imposes a
 significant burden on staff to enter data. Poor usability has a direct
 consequence and opportunity cost in staff time and resources that could
 otherwise be employed in patient care. This research measures the
 usability of EHR systems in UK EDs using a validated assessment tool.
 Methods This was a survey completed by members and fellows of the Royal
 College of Emergency Medicine conducted during summer 2019. The primary
 outcome was the System Usability Scale score, which ranges from 0 (worst)
 to 100 (best). Scores were compared to an internationally recognised
 measure of acceptable usability of 68. Results were analysed by EHR
 system, country, healthcare organisation and physician grade. Only EHR
 systems with at least 20 responses were analysed. Results There were 1,647
 responses from a total population of 8,794 (19%) representing 192
 healthcare organisations (mainly UK National Health Service), and 25 EHR
 systems. Fifteen EHR systems had at least 20 responses and were included
 in the analysis. No EHR system achieved a median usability score that met
 the industry standard of acceptable usability. The median usability score
 was 53 (interquartile range [IQR] 35 – 68). Individual EHR systems’ scores
 ranged from 35 (IQR 26 to 53) to 65 (IQR 44 to 80). Conclusion In this
 survey, no UK ED EHR system met the internationally validated standard of
 acceptable usability for information technology. Better usability of
 emergency department EHRs is a cheap and effective way of increasing staff
 productivity.
description: This was
 an open web-based survey run by the Royal College of Emergency Medicine
 (RCEM) Informatics Committee. A survey tool (REDCap,
 https://www.project-redcap.org/) was used to survey members and fellows of
 RCEM using the System Usability Scale from 25/06/19 to
 15/08/19.  The System
 Usability Scale has a minimum value of 0 and a maximum value of 100. We
 defined acceptable usability as a System Usability Scale score of ≥ 68. A
 score of 68 is both an average score across industries, and the threshold
 of acceptable usability (Figure 1).<sup>10,11</sup>  The
 System Usability Scale was treated as continuous, and also dichotomised
 into acceptable and non-acceptable usability at a threshold of 68. EHR
 system, country, healthcare organisation, consultant status (consultants
 vs. non-consultants), and trainee status (trainees vs. non-trainees) were
 a priori defined as potential predictive variables of acceptable
 usability. Physician grade was categorised in this way to include Staff
 Grade, Associate Specialist and Specialty Grade (SAS) doctors, who occupy
 neither training nor consultant grades. In addition, respondents were
 asked whether their system can link directly, or whether users have to log
 into a separate system, to access blood tests,  x-rays, out-patient notes,
 or primary care notes. Lastly, respondents were asked whether they wished
 to be contacted to take part in future usability work.
description: There are two tabs; <em>Data</em> and <em>EHR
 system key</em>
 <em>Data </em>contains five columns; a respondent ID,
 Healthcare organisation code (anonymised code representing NHS trust or
 board, or other unit of healthcare organisation), EHR system (the vendor
 of the EHR), EHR system code (a numerical code unique to each EHR system,
 included for ease of analysis), and the System Usability Scale score
 calculated for each respondent (SUS). <em>EHR
 system key </em>contains the unique numerical code and EHR system to
 which the code refers. There are missing
 values.