Measurement of the clinical usability of a configurable EHR.

The objective of the project was to measure the clinical usability of an EHR configured by use of participatory design with clinicians from a neurological stroke unit in order to get input to the County's future strategy for incremental implementation of EHR. The content of the EHR was defined during a series of workshops with the clinicians after which the XML configuration files were written and deployed. In parallel with this, the participants from the University identified, prioritised and further specified a number of effects related to the clinical practice to be measured. The effects requested by the clinicians focused on improving their overview and assessment of patients as well as on more efficient coordination in three specific and highly cooperative situations, viz. nursing handover, ward round and patient conference. All three situations were measured before (using paper-based medical records) as well as during the week where the configured EHR completely replaced the paper-based medical record in order to compare a 'before' and 'after' situation. Measurements were focused on the requested effects and acquired using various techniques including questionnaires, interviews, observations, and Task Load Index (TLX) ratings. In total, 15 nursing handovers, 8 ward rounds, and 11 patient conferences involving a total of 35 patients and more than 20 clinicians were included in the measurements. Data from the project has been comparatively analysed by means of the TLX scores. Our results show several significant results, for example, during ward rounds the physicians experienced a significant improvement of TLX. The experiment has proven it possible to configure the content of an EHR that significantly improves the clinician's overview of the patient's current status in different clinical situations during the clinical process, based on the clinician's actual needs. Furthermore, the configuration process gave the County valuable experience concerning the content and management of a participatory design process as well as documentation of utility value that will be incorporated in future EHR projects.