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“Design is intelligence made visible.”

-Alina Wheeler


  • Define usability in the context of healthcare IT.

  • Describe usability concepts through common clinical scenarios.

  • Evaluate system usability using tools provided.

  • Understand current state and future considerations of usability.


Healthcare leaders are increasingly expressing dissatisfaction with their clinical information systems, and often cite cost and difficulty of use as contributing factors (Gregg, 2014). Face it: Electronic health records (EHRs) and order-entry systems are complex and typically lack intuitiveness, and navigation does not always support a smooth workflow. The Healthcare Information and Management Systems Society (HIMSS) Electronic Health Record Usability Task Force report cited that usability was perhaps the most important factor that hindered the widespread adoption of EHRs prior to the signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 (Belden, Grayson, & Barnes, 2009). Since then, organizations have worked quickly to get these clinical systems in place to take advantage of the incentive dollars offered through the Centers for Medicare and Medicaid Services (CMS) Meaningful Use incentive program (ONC, 2013). Adoption has been swift since 2009, yet enhancements to usability have been slow.

The challenges that we face regarding usability in healthcare IT are several. First, there is no standard and accepted definition of usability in the healthcare IT industry. Several are offered that are very good, but none seem to be the gold standard from which we all work. Nielson (1995) defined usability as “a quality attribute that assesses how easy the user interfaces are to use.”

Further, Zhang and Walji (2011) noted that usability “…refers to how useful, usable, and satisfying a system is for the intended users to accomplish goals by performing certain sequences of tasks” (p. 1056).

Second, we have the issue of individual perspectives and paradigms. What may make perfect sense on a display screen to one person may not be as clear to another. Reasons for this are several and may be due to the person's level of exposure to technology, their age and education, and perhaps gender.

The bottom line is that healthcare is complex, EHRs are complex, and attempting to visually display the nonlinear work of caring for patients is a huge challenge. However, several core concepts that are evidence-based can help lay a strong foundation for those informaticists working in the area of system design. This chapter will focus on those core concepts and give readers the tools to evaluate and improve their systems.


The current state of usability leaves us with much work to do in a complex and fast-paced, ever-changing environment. Middleton et al. (2013, p. 3), in a position paper on behalf of the American Medical Informatics Association (AMIA), stated, “[T]he ability to perform meaningful, reproducible, objective usability metrics for ...

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