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In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.

Loppukäyttäjien osallistuminen potilastietojärjestelmien kehittämiseen on keskeistä, jotta järjestelmiä voidaan kehittää heidän tarpeitaan vastaaviksi ja työtehtäviin sopiviksi. Sairaanhoitajien ja lääkärien osallistumista käyttämiensä tietojärjestelmien kehittämistyöhön selvitettiin valtakunnallisten kyselytutkimusten avulla. Sairaanhoitajien aineisto kerättiin keväällä 2017. Lääkärien kyselytutkimus toteutettiin samoin keväällä 2017 ja lisäksi vuosina 2014 ja 2010, tosin vuonna 2017 lääkäreiltä ei kysytty kehittämiseen osallistumisen tavoista. Kyselyyn vastanneista sairaanhoitajista 46 % ja lääkäreistä 49 % kertoi osallistuneensa tietojärjestelmien kehittämistyöhön. Sairaanhoitajista 21 % oli valmiita osallistumaan kehittämisryhmiin ja vain 20 % ei ollut lainkaan kiinnostuneita osallistumaan; vuoden 2014 kyselyssä lääkäreillä vastaavat osuudet olivat 18 % ja 16 %. Ohjelmistotoimittajien ei koettu olevan kiinnostuneita loppukäyttäjien näkemyksistä eikä kehittämisehdotuksia toteutettu toivotulla tavalla eikä ripeydellä. Verrattuna vuosiin 2010 ja 2014 lääkärien arviot eivät olleet muuttuneet positiivisemmiksi. Loppukäyttäjistä suuri osa olisi halukkaita osallistumaan kehittämistyöhön jollakin tavalla, mutta ohjelmistokehitys ei ole toistaiseksi löytänyt parhaita tapoja heidän osallistumisensa mahdollistamiseen. On ilmeistä, että loppukäyttäjät eivät koe pystyvänsä vaikuttamaan ohjelmistokehitykseen toivotulla tavalla. Osallistamisen on myös oltava mahdollista osana jokapäiväistä työtä. Terveydenhuollon organisaatioiden on tunnistettava kehittämistyöhön osallistumisen merkitys ja mahdollistettava esimerkiksi tietojärjestelmälääkärien ja -hoitajien urapolut. Tärkeää on, että tietojärjestelmiä kehittävien lääkäreiden ja sairaanhoitajien kliininen työ jatkuu tietojärjestelmien kehittämisen rinnalla, jotta näkemys työhön, missä järjestelmiä käytetään, säilyy., End user participation in healthcare IT system development is essential in order to develop systems that fit together with healthcare professionals’ work tasks and needs. National questionnaire studies were conducted to explore how nurses and physicians participate in system development and what kind of experiences they have on participation. The questionnaire to nurses was conducted in spring 2017. Similarly, the questionnaire to physicians was conducted in spring 2017 but also earlier in 2010 and in 2014. The number of respondents was 4018 for physicians and 3607 for nurses. Participation rates in the system development were following: 46% of the nurses and 49% of the physicians had participated in the system development. 21% of the nurses were willing to participate in the development groups and 20% were not willing to participate at all. The physicians’ rates were 18% and 16% in 2014, respectively. Depending on the used software, 43 - 93 % of the respondents felt that software vendors were not interested in the views and opinions of the end users, nor did the proposed improvements take place in the desired manner or quick enough. Compared to years 2010 and 2014, physicians’ opinions had not changed more positive. The study results indicate that a large number of the end users would be willing to participate in healthcare IT system development. However, suitable methods and appropriate practices on how to involve end users in development work seem to be lacking. The results indicate that end users feel not to be able to influence to the development in the way they wish. The participation should take place as a part of the daily work. Healthcare organisations need to recognise the importance of participating in development work and, for example, enable career paths for IT physicians and nurses. It is important that the clinical work of physicians and nurses who develop information systems, will continue alongside the development to keep the practical “touch” to work in which systems are being used.

Background: Poorly functioning, time-consuming, and inadequate information systems are among the most important work-related psychosocial factors causing stress in physicians. The present study examined the trend in the perceived stress that was related to information systems (SRIS) among Finnish physicians during a nine-year follow-up. In addition, we examined the associations of gender, age, employment sector, specialization status, leadership position, on-call burden, and time pressure with SRIS change and levels. Methods: A longitudinal design with three survey data collection waves (2006, 2010 and 2015) based on a random sample of Finnish physicians in 2006 was used. The study sample included 1095 physicians (62.3% women, mean age 54.4 years) who provided data on SRIS in every wave. GLM repeated measures analyses were used to examine the associations between independent variables and the SRIS trend during the years 2006, 2010, and 2015. Results: SRIS increased during the study period. The estimated marginal mean of SRIS in 2006 was 2.80 (95% CI = 2.68-2.92) and the mean increase was 0.46 (95% CI = 0.30-0.61) points from 2006 to 2010 and 0.25 (95% CI = 0.11-0.39) points from 2010 to 2015. Moreover, our results show that the increase was most pronounced in primary care, whereas in hospitals SRIS did not increase between 2010 and 2015. SRIS increased more among those in a leadership position. On-call duties and high time-pressures were associated with higher SRIS levels during all waves. Conclusions: Changing, difficult, and poorly functioning information systems (IS) are a prominent source of stress among Finnish physicians and this perceived stress continues to increase. Organizations should implement arrangements to ease stress stemming from IS especially for those with a high workload and on-call or leadership duties. To decrease IS-related stress, it would be important to study in more detail the main IS factors that contribute to SRIS. Earlier studies indicate that the usability and stability of information systems as well as end-user involvement in system development and work-procedure planning may be significant factors.

Purpose: Survey studies of health information systems use tend to focus on availability of functionalities, adoption and intensity of use. Usability surveys have not been systematically conducted by any healthcare professional groups on a national scale on a repeated basis. This paper presents results from two cross-sectional surveys of physicians' experiences with the usability of currently used EHR systems in Finland. The research questions were: To what extent has the overall situation improved between 2010 and 2014? What differences are there between healthcare sectors? Methods: In the spring of 2014, a survey was conducted in Finland using a questionnaire that measures usability and respondents' user experiences with electronic health record (EHR) systems. The survey was targeted to physicians who were actively doing clinical work. Twenty-four usability-related statements, that were identical in 2010 and 2014, were analysed from the survey. The respondents were also asked to give an overall rating of the EHR system they used. The study data comprised responses from 3081 physicians from the year 2014 and from 3223 physicians in the year 2010, who were using the nine most commonly used EHR system brands in Finland. Results: Physicians' assessments of the usability of their EHR system remain as critical as they were in 2010. On a scale from 1 ('fail') to 7 ('excellent') the average of overall ratings of their principally used EHR systems varied from 3.2 to 4.4 in 2014 (and in 2010 from 2.5 to 4.3). The results show some improvements in the following EHR functionalities and characteristics: summary view of patient's health status, prevention of errors associated with medication ordering, patient's medication list as well as support for collaboration and information exchange between the physician and the nurses. Even so, support for cross-organizational collaboration between physicians and for physician-patient collaboration were still considered inadequate. Satisfaction with technical features had not improved in four years. The results show marked differences between the EHR system brands as well as between healthcare sectors (private sector, public hospitals, primary healthcare). Compared to responses from the public sector, physicians working in the private sector were more satisfied with their EHR systems with regards to statements about user interface characteristics and support for routine tasks. Overall, the study findings are similar to our previous study conducted in 2010. Conclusions: Surveys about the usability of EHR systems are needed to monitor their development at regional and national levels. To our knowledge, this study is the first national eHealth observatory questionnaire that focuses on usability and is used to monitor the long-term development of EHRs. The results do not show notable improvements in physician's ratings for their EHRs between the years 2010 and 2014 in Finland. Instead, the results indicate the existence of serious problems and deficiencies which considerably hinder the efficiency of EHR use and physician's routine work. The survey results call for considerable amount of development work in order to achieve the expected benefits of EHR systems and to avoid technology-induced errors which may endanger patient safety. The findings of repeated surveys can be used to inform healthcare providers, decision makers and politicians about the current state of EHR usability and differences between brands as well as for improvements of EHR usability. This survey will be repeated in 2017 and there is a plan to include other healthcare professional groups in future surveys. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.