Usability challenges with electronic health records (EHRs) during prerounding on pediatric inpatients

Objective Prerounding is critical for a healthcare team to develop a shared understanding of the patient's condition and to develop a care plan. However, the design of electronic health records (EHRs) often makes prerounding inefficient, ineffective, and time consuming. The goal of this study was to observe how residents use the EHR while prerounding to identify usability challenges associated with the design of EHRs. Materials and Methods Thirty residents were tasked to preround 2 pediatric patients using the think-aloud protocol. The data from the surveys, video recordings, and think-aloud comments were analyzed to identify usability issues related to EHR. The time it took for participants to complete the 6 required prerounding tasks were calculated and the pages most commonly accessed were noted. Results Participants spent on average 6.5 min prerounding each patient with the most time spent on checking lab results and reviewing notes. Twenty-eight distinct pages were visited by at least 2 participants, mostly due to a lack of interconnectivity between related data across pages. Usability issues with the most commonly used pages include: data overload, missing/hidden information, difficulty identifying trends, and having to conduct manual calculations. Conclusions We list usability issues and provide a set of recommendations to remedy these issues that include: reducing information access cost, creating a checklist, automate calculations, and standardizing notes and EHR training. Ideally, the outcome of this work will help improve EHR design to maximize the time clinicians spend interacting with and providing care to their patients. Lay Summary Residents spend a significant amount of time using the electronic health record (EHR) system and these interactions can often be frustrating, inefficient, and time consuming. This study focuses on identifying challenges associated with EHR use during prerounding by residents. As part of this study, we observed 30 residents while they preround 2 pediatric care patients using the EHR system. The results of our study showed that the design of EHRs currently do not support the tasks the residents need to perform while prerounding. Patient data are spread across numerous pages within the EHR system and the information is often not displayed in the most user friendly manner. This adversely affects the effectiveness and efficiency of prerounding. This study provides a set of recommendations to support prerounding that include dashboard design guidelines, standardizing data entry, and automating certain tasks within the EHR.