Electronic health record usability and workload changes over time for provider and nursing staff following transition to new EHR.


Dunn Lopez K(1), Chin CL(2), Leitão Azevedo RF(3), Kaushik V(4), Roy B(4), Schuh W(5), Banks K(5), Sousa V(6), Morrow D(3).
Author information:
(1)University of Iowa, College of Nursing, United States. Electronic address: [Email]
(2)University of Illinois at Urbana-Champaign, School of Information Sciences, United States.
(3)University of Illinois at Urbana-Champaign, College of Education, United States; University of Illinois at Urbana-Champaign, Beckman Institute, United States.
(4)University of Illinois at Urbana-Champaign, Beckman Institute, United States.
(5)Carle Hospital, Urbana, IL, United States.
(6)Universidade da Integração Internacional da Lusofonia Afro-Brasileira
(Unilab), Redenção, Brazil.


The ubiquity of EHRs in healthcare means that small EHR inefficiencies can have a major impact on clinician workload. We conducted a sequential explanatory mixed methods study to: 1) identify EHR-associated workload and usability effects for clinicians following an EHR change over time, 2) determine workload and usability differences for providers (MD and Advance Practice Nurses) versus nurses (RNs and MAs), 3) determine if usability predicts workload, 4) identify potential sources of EHR design flaws. Workload (NASA-Task Load Index) and usability (System Usability Scale) measures were administered pre, 6-8 month and 30-32 months post-implementation. We found significant increase in perceived workload post-implementation that persisted for 2.5 years (p < .001). The workload increase was associated with usability ratings, which in turn may relate to EHR interface design violations identified by a heuristic evaluation. Our findings suggest further innovation and attention to interface design flaws are needed to improve EHR usability and reduce clinician workload.