The design and testing of usable
EHRs should become a critical
item not only on the agenda of HCI
and usability professionals, but
for all healthcare policy makers.
Publishing articles like the ones
featured in interactions is a positive
step by sharing useful tactics. As
a professional community, we still
need to develop a broader strategy
to address the unique challenges
of the healthcare discipline.
Swanson and Lind elucidate essential issues in making EHR systems
usable, useful, and appealing.
We know things can be done.
We know things can improve.
A crucial catalyst is convincing top executives with budgets
and decision-making power to
get behind such initiatives. In
this regard, our experience has
shown it is important to prepare
and present executive marketing
presentations that show clearly
what is proposed and the risks of
doing nothing. These presentations
are often crucial in paving the
way for the more “mainstream”
work of design and evaluation.
It does occur to me that the
issues they discuss could be
enhanced by consideration of top-
ics not emphasized as much as our
own experience shows them to be
• How do cross-cultural differ-
ences affect how information is col-
lected, managed, shown, and used?
• How do cross-cultural differences affect team operations,
workflow, concepts of leadership,
and patient/family relations and
• How do mobile devices affect
any and all gathering, dissemination, and use of EHRs?
• How do social networks affect
EHR systems? How might these be
used to provide incentives to best
practices and to reduce impediments to collection, maintenance,
The article provides a very practical perspective on what needs
to be done. I hope medical informatics policy makers will take
note—and take action—to remedy
a situation that is, in some cases,
in crisis mode, and in others an
embarrassment in consideration
of the power of technology to
improve our lives.
President, Aaron Marcus and
We think it’s important to note
that while our article was spurred
by the NIST EUP, it is not about
the EUP. It is about the chal-
lenges in usability testing EHRs.
Some argue that the EUP does
not aim to use summative test-
ing to compare EHRs. While that
may not be a goal of the protocol
itself, there have been a number
of stakeholders throughout the
process who have indicated the
protocol was likely a precursor to
comparative testing, and the draft
protocol references a common CIF
reporting structure for results to
be submitted. This is enforced by
Keith Butler’s comments about the
NIST protocol and CIF describing
the need for EHR purchasers to
have concrete data about system
usability when making purchasing
decisions. This is the fundamental
question: Is a protocol such as the
one proposed by NIST going to
generate repeatable, generalizable,
and valid usability testing data
that will benefit EHR customers?
Butler argues from an academic
perspective, and we argue from
practical experience. We need to
work toward common ground.
March + April 2012
© 2012 ACM 1072-5220/12/03 $10.00