Active Involvement of End-Users in an EHR Procurement Process: a Usability Walkthrough Feasibility Case Study

Introduction . Despite federal incentives promoting user-centered design processes during electronic health record (EHR) development, poor EHR usability remains a workflow and safety problem. Usability depends on alignment between EHR characteristics, user attributes, and context of use. Therefore, end-users should participate in EHR procurement to select a product that best fits business needs. Instead, end-users are often relegated to the organizational fringes during technology demonstrations and selection. We hypothesized that a usability walkthrough could enable end-users to evaluate EHR usability – even in resource-constrained settings. This article assesses the feasibility of this method using a real-world case study of an EHR procurement. Method . As part of the hospital’s transition to a new EHR, we organized a usability walkthrough for clinical staff. Nine representative end-users identified and categorized a range of usability issues. Our team’s experts gathered user feedback and perceptions about the walkthrough using a mixed-methods approach. Finally, we tracked deviations from the planned protocol to identify implementation challenges and root causes. Results . Participants detected 258 usability problems, and usability experts identified 7 additional usability problems. Both groups generally agreed on usability criteria and severity scores (Krippendorff’s α = 0.66 and = 0.75, respectively). Thirty-two problems required clinical domain expertise to be identified. Participants indicated they liked the method and would use it for future technology purchases. Vendor preparation oversights caused protocol and timeline deviations; the EHRs were not always properly populated or configured for the walkthroughs. Discussion . The usability walkthrough is a feasible method to involve end-users in EHR evaluation during a procurement process. Engaging clinical domain experts is crucial to identify usability issues that might otherwise be missed.