Usability perception of the health information systems in Brazil: the view of hospital health professionals on the electronic health record

Authors

  • Universidade de Caxias do Sul
  • Universidade de Caxias do Sul
  • Cintia Paese Giacomello Universidade de Caxias do Sul
  • Franciele Dalle Molle Universidade de Caxias do Sul
  • Univerasidade de Caxias do Sul

DOI:

https://doi.org/10.1108/RAUSP-02-2021-0023

Keywords:

Usability, Health information system, Electronic medical record, Electronic health record, National Usability-focused HIS Scale (NuHISS)

Abstract

Purpose

The purpose of this paper is to validate and measure the overall evaluation of electronic health record (EHR) and identify the factors that influence the health information systems (HIS) assessment in Brazil.

Design/methodology/approach

From February to May 2020, this study surveyed 262 doctors and nurses who work in hospitals and use the EHR in their workplace. This study validated the National Usability-focused HIS Scale (NuHISS) to measure usability in the Brazilian context.

Findings

The results showed adequate validity and reliability, validating the NuHISS in the Brazilian context. The survey showed that 38.9% of users rated the system as high quality. Technical quality, ease of use and benefits explained 43.5% of the user’s overall system evaluation.

Research limitations/implications

This study validated the items that measure usability of health-care systems and identified that not all usability items impact the overall evaluation of the EHR.

Practical implications

NuHISS can be a valuable tool to measure HIS usability for doctors and nurses and monitor health systems’ long-term usability among health professionals. The results suggest dissatisfaction with the usability of HIS systems, specifically the EHR in hospital units. For this reason, those responsible for health systems must observe usability. This tool enables usability monitoring to highlight information system deficiencies for public managers. Furthermore, the government can create and develop actions to improve the existing tools to support health professionals.

Social implications

From the scale validation, public managers could monitor and develop actions to foster the system’s usability, especially the system’s technical qualities – the factor that impacted the overall system evaluation.

Originality/value

To the best of the authors’ knowledge, this study is the first to validate the usability scale of EHR systems in Brazil. The results showed dissatisfaction with HIS and identified the factors that most influence the system evaluation.

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References

Boonstra, A., & Broekhuis, M. (2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Services Research, 10(1), 231, doi: 10.1186/1472-6963-10-231.

Brasil. (2018). Lei n° 13.787, de 27 de dezembro de 2018. Retrieved from www.in.gov.br/materia/-/asset_publisher/Kujrw0TZC2Mb/content/id/57221806/do1-2018-12-28-lei-n-13-787-de-27-de-dezembro-de-2018-57221499

Bundschuh, B. B., Majeed, R. W., Bürkle, T., Kuhn, K., Sax, U., Seggewies, C., & Röhrig, R. (2011). Quality of human-computer interaction – results of a national usability survey of hospital-IT in Germany. BMC Medical Informatics and Decision Making, 11(1), 69, doi: 10.1186/1472-6947-11-69.

Castillo, V. H., Martínez-García, A. I., & Pulido, J. (2010). A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Medical Informatics and Decision Making, 10(1), 60, doi: 10.1186/1472-6947-10-60.

Colleti Junior, J., de Andrade, A. B., & Carvalho, W. B. D. (2018). Evaluation of the use of electronic medical record systems in Brazilian intensive care units. Revista Brasileira de Terapia Intensiva, 30(3), 338–346, doi: 10.5935/0103-507X.20180057.

Feldman, S. S., Buchalter, S., & Hayes, L. W. (2018). Health information technology in healthcare quality and patient safety: literature review. JMIR Medical Informatics, 6(2), e10264, doi: 10.2196/10264.

Fennelly, O., Cunningham, C., Grogan, L., Cronin, H., O'Shea, C., Roche, M. & O'Hare, N. (2020). Successfully implementing a national electronic health record: a rapid umbrella review. International Journal of Medical Informatics, 144(1), 104281, doi: 10.1016/j.ijmedinf.2020.104281.

Fornell, C., & Larcker, D. F. (1981). Structural Equation Models with Unobservable Variables and Measurement Error: Algebra and Statistics, Los Angeles, CA: SAGE Publications.

Gomes, K. M., & Ratwani, R. M. (2019). Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability. JAMA Network Open, 2(12), e1916651, doi: 10.1001/jamanetworkopen.2019.16651.

Gonçalves, J. P. P., Batista, L. R., Carvalho, L. M., Oliveira, M. P., Moreira, K. S., & Leite, M. T. D S. (2013). Prontuário Eletrônico: uma ferramenta que pode contribuir para a integração das Redes de Atenção à Saúde. Saúde Em Debate, 37(96), 43–50, doi: 10.1590/S0103-11042013000100006.

Hair, J. F., Jr, Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis, 7th ed., Englewood Cliffs, NJ: Prentice Hall.

Heponiemi, T., Hyppönen, H., Kujala, S., Aalto, A.-M., Vehko, T., Vänskä, J., & Elovainio, M. (2018). Predictors of physicians’ stress related to information systems: a nine-year follow-up survey study. BMC Health Services Research, 18(1), 284, doi: 10.1186/s12913-018-3094-x.

Heponiemi, T., Kujala, S., Vainiomäki, S., Vehko, T., Lääveri, T., Vänskä, J., … Hyppönen, H. (2019). Usability factors associated with physicians’ distress and information system–related stress: cross-sectional survey. JMIR Medical Informatics, 7(4), doi: 10.2196/13466. e13466.

Holden, R. J. (2011). What stands in the way of technology-mediated patient safety improvements? A study of facilitators and barriers to physicians’ use of electronic health records. Journal of Patient Safety, 7(4), 193–203, doi: 10.1097/PTS.0b013e3182388cfa.

Howe, J. L., Adams, K. T., Hettinger, A. Z., & Ratwani, R. M. (2018). Electronic health record usability issues and potential contribution to patient harm. JAMA, 319(12), 1276, doi: 10.1001/jama.2018.1171.

Hudson, D., Kushniruk, A., Borycki, E., & Zuege, D. J. (2018). Physician satisfaction with a critical care clinical information system using a multimethod evaluation of usability. International Journal of Medical Informatics, 112(1), 131–136, doi: 10.1016/j.ijmedinf.2018.01.010.

Hyppönen, H., Kaipio, J., Heponiemi, T., Lääveri, T., Aalto, A.-M., Vänskä, J., & Elovainio, M. (2019a). Developing the national usability-focused health information system scale for physicians: validation study. Journal of Medical Internet Research, 21(5), e12875, doi: 10.2196/12875.

Hyppönen, H., Lumme, S., Reponen, J., Vänskä, J., Kaipio, J., Heponiemi, T., & Lääveri, T. (2019b). Health information exchange in Finland: usage of different access types and predictors of paper use. International Journal of Medical Informatics, 122, 1–6, doi: 10.1016/j.ijmedinf.2018.11.005.

Instituto Brasileiro de Geografia e Estatística (IBGE). (2010). Censo 2010. Retrieved from https://censo2010.ibge.gov.br/ ISO. (2019). ISO 9241-210:2019 - Ergonomics of human-system interaction – part 210: human-centred design for interactive systems. Retrieved from www.iso.org/standard/77520.html

Kaipio, J., Kuusisto, A., Hyppönen, H., Heponiemi, T., & Lääveri, T. (2020). Physicians’ and nurses’ experiences on EHR usability: comparison between the professional groups by employment sector and system brand. International Journal of Medical Informatics, 134(1), 104018, doi: 10.1016/j.ijmedinf.2019.104018.

Kaipio, J., Lääveri, T., Hyppönen, H., Vainiomäki, S., Reponen, J., Kushniruk, A. & Vänskä, J. (2017). Usability problems do not heal by themselves: national survey on physicians’ experiences with EHRs in Finland. International Journal of Medical Informatics, 97(1), 266–281, doi: 10.1016/j.ijmedinf.2016.10.010.

Kline, R. B. (2015). Principles and Practice of Structural Equation Modeling, New York, NY: Guilford publications.

Larsen, E., Fong, A., Wernz, C., & Ratwani, R. M. (2018). Implications of electronic health record downtime: an analysis of patient safety event reports. Journal of the American Medical Informatics Association, 25(2), 187–191, doi: 10.1093/jamia/ocx057.

Lawrence, J. E., Cundall-Curry, D., Stewart, M. E., Fountain, D. M., & Gooding, C. R. (2019). The use of an electronic health record system reduces errors in the National Hip Fracture Database. Age and Ageing, 48(2), 285–290, doi: 10.1093/ageing/afy177.

Martikainen, S., Kaipio, J., & Lääveri, T. (2020). End-user participation in health information systems (HIS) development: physicians’ and nurses’ experiences. International Journal of Medical Informatics, 137(1), 104117, doi: 10.1016/j.ijmedinf.2020.104117.

Mazur, L. M., Mosaly, P. R., Moore, C., & Marks, L. (2019). Association of the usability of electronic health records with cognitive workload and performance levels among physicians. JAMA Network Open, 2(4), doi: 10.1001/jamanetworkopen.2019.1709. e191709.

Melnick, E. R., Dyrbye, L. N., Sinsky, C. A., Trockel, M., West, C. P., Nedelec, L. & Shanafelt, T. (2020). The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clinic Proceedings, 95(3), 476–487, doi: 10.1016/j.mayocp.2019.09.024.

Miller, R. H., & Sim, I. (2004). Physicians’ use of electronic medical records: barriers and solutions. Health Affairs, 23(2), 116–126, doi: 10.1377/hlthaff.23.2.116.

Paim, J., Travassos, C., Almeida, C., Bahia, L., & Macinko, J. (2011). O sistema de saúde brasileiro: história, avanços e desafios. In Saúde No Brasil, 1, 11–31, doi: 10.1016/S0140- 6736(11)60054-8.

Pinto, L. F., & Santos, L. J. D. (2020). Prontuários eletrônicos na Atenção Primária: gestão de cadastros duplicados e contribuição para estudos epidemiológicos. Ciência & Saúde Coletiva, 25(4), 1305–1312, doi: 10.1590/1413-81232020254.34132019.

Ratwani, R. M., Savage, E., Will, A., Arnold, R., Khairat, S., Miller, K. & Hettinger, A. Z. (2018). A usability and safety analysis of electronic health records: a multi-center study. Journal of the American Medical Informatics Association, 25(9), 1197–1201, doi: 10.1093/jamia/ocy088.

Roman, L. C., Ancker, J. S., Johnson, S. B., & Senathirajah, Y. (2017). Navigation in the electronic health record: a review of the safety and usability literature. Journal of Biomedical Informatics, 67(1), 69–79, doi: 10.1016/j.jbi.2017.01.005.

Sellera, P. E. G., Pedebos, L. A., Harzheim, E., de Medeiros, O. L., Ramos, L. G., Martins, C., & D’Avila, O. P. (2020). Monitoramento e avaliação dos atributos da Atenção Primária à Saúde em nível nacional: novos desafios. Ciência & Saúde Coletiva, 25(4), 1401–1412, doi: 10.1590/1413-81232020254.36942019.

Silva, A. B., Guedes, A. C. C. M., Síndico, S. R. F., Vieira, E. T. R. C., & Filha, I. G. D A. (2019). Registro eletrônico de saúde em hospital de alta complexidade: um relato sobre o processo de implementação na perspectiva da telessaúde. Ciência & Saúde Coletiva, 24(3), 1133–1142, doi: 10.1590/1413-81232018243.05982017.

Singh, A., Jadhav, S., & Roopashree, M. (2020). Factors to overcoming barriers affecting electronic medical record usage by physicians. Indian Journal of Community Medicine, 45(2), 168, doi: 10.4103/ijcm.IJCM_478_19.

Topaz, M., Ronquillo, C., Peltonen, L. M., Pruinelli, L., Sarmiento, R. F., Badger, M. K. & Lee, Y. L. (2016). Nurse informaticians report low satisfaction and multi-level concerns with electronic health records: results from an international survey. Annual Symposium Proceedings. AMIA Symposium, 2016, 2016–2025. 28269961.

Vaidotas, M., Yokota, P. K. O., Negrini, N. M. M., Leiderman, D. B. D., de Souza, V. P., Dos Santos, O. F. P., & Wolosker, N. (2019). Medication errors in emergency departments: is electronic medical record an effective barrier? Einstein (São Paulo), 17(4), 1–5, doi: 10.31744/einstein_journal/2019GS4282.

Vainiomäki, S., Aalto, A.-M., Lääveri, T., Sinervo, T., Elovainio, M., Mäntyselkä, P., & Hyppönen, H. (2017). Better usability and technical stability could lead to better work-related well-being among physicians. Applied Clinical Informatics, 8(4), 1057–1067, doi: 10.4338/ACI-2017-06-RA-0094.

Viitanen, J., Hyppönen, H., Lääveri, T., Vänskä, J., Reponen, J., & Winblad, I. (2011). National questionnaire study on clinical ICT systems proofs: physicians suffer from poor usability. International Journal of Medical Informatics, 80(10), 708–725, doi: 10.1016/j.ijmedinf.2011.06.010.

Walter, Z., & Lopez, M. S. (2008). Physician acceptance of information technologies: role of perceived threat to professional autonomy. Decision Support Systems, 46(1), 206–215, doi: 10.1016/j.dss.2008.06.004.

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Published

2022-08-07

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Section

Research Paper