Improvements in EHR usability during eleven years: Cross-sectional surveys on specialist physicians' experiences in...

Usability not only impacts user satisfaction but also the efficiency and effectiveness of electronic health record (EHR) use. Moreover, poor EHR usability is associated with physician burnout and stress. Despite an abundance of research and investments in improving usability, long-term monitoring studies are scarce. Our aim was to explore how the usability of EHR systems has evolved over an 11-year period in Finland from specialist physicians' perspectives and to compare user experiences (UXs) between specialties.

Nationwide usability-focused cross-sectional surveys were conducted among Finnish physicians in 2010, 2014, 2017, and 2021. To measure usability, we selected six usability-related statements from the validated National Usability-focused Health Information System Scale (NuHISS). The responses of specialist physicians with more than six months of system use (n = 2473 in 2021; 2137 in 2017; 2162 in 2014; and 2312 in 2010) were selected and analyzed by specialty group and study year.

During the study years, UXs improved across all specialty groups. A positive change was seen particularly in occupational healthcare (OH) and nonsurgical medical specialties. However, the Net EHR Experience Scores (NEESs) remained negative for all groups, except for physicians working in anesthesiology and intensive care. In 2021, physicians working in OH and general practice were more positive about EHR usability, whereas those in psychiatric specialties gave more negative assessments than other groups.

Despite improvements over the study years, most physicians remained dissatisfied with EHRs. Interestingly, the positive development was not linear; during 2014-17, NEESs decreased, coinciding with the implementation of the national health information exchange services. Our findings suggest that efforts to improve EHR usability and enhance end-user skills only slowly translate into better UXs. To distinguish the effect of factors such as national requirements or recently implemented EHR brands, continuous monitoring of UXs using context-adapted surveys like NuHISS is crucial.