Textbook of Usability

Also known as: EHR, EMR, electronic medical record

An electronic health record (EHR) is a digital system for recording and managing patient clinical data — replacing the paper charts that dominated healthcare until the early 2000s. Modern EHRs (Epic, Cerner, Meditech, and others) are among the most complex pieces of software in routine use, with thousands of screens, tens of thousands of data fields, and workflows that vary by clinical specialty, patient acuity, and institutional policy.

EHRs have introduced documented usability problems that contribute to clinician burnout and patient safety risks:

• Documentation burden: physicians spend 1–2 hours on EHR documentation for every hour of direct patient care
• Excessive clicking: some emergency department physicians log 4,000+ clicks per 10-hour shift
• Copy-forward errors: copied notes propagate stale information across encounters
• Fragmented information: related data scattered across multiple screens, causing split-attention
• Alert fatigue from excessive CDS alerts
• Poor workflow integration between modules and external systems

The Koppel et al. (2005) landmark study identified 22 ways in which a widely deployed CPOE system facilitated medication errors — not through bugs but through interface design conflicting with clinical workflows.

EHR usability is a patient safety issue. Every unnecessary click, confusing label, hidden piece of information, or misleading display creates an opportunity for clinical error. The IEC 62366 standard (medical device usability engineering) increasingly applies regulatory pressure to improve EHR usability.