Abstract
According to earlier studies, Finnish physicians suffer from stress caused by poor usability of their digital tools and feel excluded from healthcare IT development. Active participation in usability evaluation could help involve doctors into developmental work, but more effective and participatory methods are needed. The objective of this study was to research whether physicians with no training in usability evaluation are able to discover usability problems using heuristic walkthrough technique. In addition, we wanted to find out if the level of EHR user experience affects the nature of the usability problems found.
 Heuristic walkthrough using a modified set of Nielsen’s heuristics and clinical tasks was performed to evaluate usability of a widely used Electronic Health Record (EHR) in Finland. Medical students and physicians with no previous experience in usability evaluation and 1) with or 2) without prior experience in using the EHR in question were recruited as evaluators. A control group of usability experts was used.
 Physicians were able to identify usability problems, ranging from cosmetic flaws to problems concerning patient safety and significant hindrance for work. Analysis of the found usability problems revealed that experienced EHR users discovered usability problems in nearly all major functions within the given scenario and time span.
 Physicians as evaluators in heuristic walkthrough has the potential to produce relevant data about EHR usability. The arrangement benefits participating physicians by introducing them to usability. Further research needs to find out, whether the suggested method could support better communication and collaboration between end-users and software developers.
Highlights
The use of an Electronic Health Record (EHR) constitutes approximately one third of a primary health care physicians working day [1]
A longitudinal study among Finnish physicians found out that stress derived from healthcare IT systems is increasing [1]
The overall aim of this study is to find out if a heuristic usability evaluation method can produce plausible results when carried out by a group of primary care physicians
Summary
The use of an Electronic Health Record (EHR) constitutes approximately one third of a primary health care physicians working day [1]. Nationwide surveys conducted in 2010, 2014 and 2017 show, that Finnish physicians repeatedly give poor grades to the usability of their EHR systems [2,3,4]. Physicians answering the questionnaires reported that EHRs support their daily work poorly, even if the user has significant experience in using the system in question. A longitudinal study among Finnish physicians found out that stress derived from healthcare IT systems is increasing [1]. Different usability assessment techniques produce different results. They are commonly used in combinations, depending on the nature and budget of the project in question. Classical heuristic evaluation technique was developed by Jakob Nielsen and Rolf Molich [10], and includes ten heuristics or rules of good user interface design. Nielsen’s heuristics are broad and non-specific, and may be applied to a large variety of devices and software, including healthcare IT systems
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