upa - home page JUS - Journal of usability studies
An international peer-reviewed journal

Usability of Electronic Medical Records

John B. Smelcer, Hal Miller-Jacobs, and Lyle Kantrovich

Journal of Usability Studies, Volume 4, Issue 2, February 2009, pp. 70-84

Article Contents


Health Care Problems and EMRs

Medical care can be a costly enterprise for any country. In the U.S., total health care costs stand at $2.2 trillion per year, or about 16% of GDP. This equates to a per capita cost of $7,421 (HHS, 2009). In contrast, most industrialized countries spend less than half that amount, typically less than $3,000 per person per year. The nationalized medical system in the U.K. spends a mere $2,317 per person per year (OECD, 2006).

Countries with wide-spread use of electronic medical records appear to have lower health care costs and better care. Many industrialized countries have improved patient care and controlled costs through the use of EMRs where they are more wide-spread than in the U.S. (Schoen, C., et al., 2006).

A recent survey of 6,000 physicians in seven industrialized countries1 shows that very high percentages of physicians use EMRs, for example, 98% of physicians in the Netherlands and 89% in the U.K. There are also strong correlations between high rates of EMR use and key indicators of clinical care, including access to after-hours care, the use of clinical teams to manage chronically ill patients, and the ability to track medical errors. There is certainly a complex relationship among EMR usage, quality of clinical care, and the implementation of nationalized medicine.

However, there is also a common sense connection between EMR use and better care. If a patient falls ill after-hours, a physician is better able to help if an EMR is available to remotely view the patient's records. Computerized health records can be easily shared with other providers to facilitate improved care. And computers are infinitely tolerant at cross checking medical interactions to prevent physicians from prescribing medicines with drug-drug reactions or allergic reactions.

Many costly medical errors, including prescription errors, could be eliminated with electronic systems (Eisenberg, 2001). The American Medical Association (AMA, 2006) enumerates eleven benefits of using an EMR system, including potential reduction in medical errors, reduced costs related to chart filing and transcription, and improved communication with other systems (AMA, 2006). There is even a Presidential initiative in the U.S. to speed the implementation of EMRs to "avoid dangerous medical mistakes, reduce costs, and improve care" (Bush, 2006).

Physicians are often enthusiastic about the coming change. In summary, they believe that better information will lead to better treatment. To quote Michael Dotti, M.D., of North Country Family Practice, "An EMR would enable us to keep better track of data. We could treat patients better because information would not fall between the cracks" (Rogoski, 2005, p. 12).

Once implemented, EMRs provide enormous benefits. Time is not lost searching for the patient's paper chart because all patient information is electronic. Time is also saved when looking through the patient's chart electronically, a faster process than scanning reams of paper. Also, physician notes and prescriptions are no longer difficult to read because they are typed. Point and click interfaces are a vast improvement over the older text-based 3270 screens. With ready access to the patient's chart, physicians can provide better care. Costs are also lower to the extent that transcriptionists and chart couriers are eliminated.

EMRs are already arriving at larger clinics and hospitals, and implementation at smaller facilities is inevitable. Unfortunately, all the news is not good.

1. Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States

Previous | Next