User-Centered Design in Real-Time: Utilization of an Insider Position to Inform Design and Adoption

Abstract

Background

Electronic health records (EHRs) have significantly impacted healthcare improving access to patient information and enhancing communication among the health care team. However, the lack of usability and increased documentation burden has greatly contributed to clinician burnout. Improvements in EHR design that include physician input are critical to developing specific changes that make EHRs more intuitive and less cumbersome to use; however, it can be challenging to gather input from physicians with full clinical workloads.

Objectives

We sought to establish a practical, repeatable framework for soliciting and integrating user-centered design elements into our vendor EHR system utilizing meaningful clinician involvement and feedback.

Methods

Over a 1-year period, physician volunteers were given access to a position within the EHR where new features were made available for testing before widespread deployment. Real-time feedback was obtained through a shared platform with institutional IS support leaders and our vendor executive and used to impact design and broader implementation decisions. Physician feedback regarding the testing process was obtained via survey.

Results

Thirteen physicians and 15 support staff were given access to a separate unique EHR position to test new EHR features during real-world clinical work at their discretion. Feedback was given via a teams chat function resulting in 1,024 messages from 28 users over a 1-year period peaking in accordance with new features made available. During two primary phases, 8 new EHR features were tested to elicit feedback prior to adoption. Six of the eight features were adopted after initial testing while two required additional changes to improve functionality prior to widespread implementation. The majority found this method intuitive and highly effective in testing new EHR features.

Conclusion

Healthcare EHR workflows are effective and well-adopted when informed and designed by clinical users. The insider position was shown to be an effective method for testing new features to gain valuable insight without overburdening clinicians.

Keywords

electronic health record - documentation burden - user-centered design

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by our Institutional Review Board.

Publikationsverlauf

Eingereicht: 27. Oktober 2024

Angenommen: 11. März 2025

Accepted Manuscript online:
12. März 2025

Artikel online veröffentlicht:
02. Juli 2025

• References

• 1 National Academies of Science, Engineering, and Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press; 2019
• 2 Kroth PJ, Morioka-Douglas N, Veres S. et al. Association of electronic health record design and use factors with clinician stress and burnout. JAMA Netw Open 2019; 2 (08) e199609
• 3 Otokiti AU, Craven CK, Shetreat-Klein A, Cohen S, Darrow B. Beyond getting rid of stupid stuff in the electronic health record (beyond-GROSS): protocol for a user-centered, mixed-method intervention to improve the electronic health record system. JMIR Res Protoc 2021; 10 (03) e25148
• 4 Rajamani G, Diethelm M, Gunderson MA. et al. Crowdsourcing electronic health record improvements at scale across an integrated health care delivery system. Appl Clin Inform 2023; 14 (02) 356-364
• 5 Göttgens I, Oertelt-Prigione S. The application of human-centered design approaches in health research and innovation: a narrative review of current practices. JMIR Mhealth Uhealth 2021; 9 (12) e28102
• 6 Desai AV, Michael CL, Kuperman GJ. et al. A novel patient values tab for the electronic health record: a user-centered design approach. J Med Internet Res 2021; 23 (02) e21615
• 7 Morse B, Anstett T, Mistry N. et al. User-centered design to reduce inappropriate blood transfusion orders. Appl Clin Inform 2023; 14 (01) 28-36
• 8 Busse TS, Jux C, Laser J. et al. Involving health care professionals in the development of electronic health records: scoping review. JMIR Hum Factors 2023; 10: e45598
• 9 Haynes D, Cheng P, Weaver M, Parsons H, Karaca-Mandic P. A human-centered approach for designing a social care referral platform. Appl Clin Inform 2025; 16 (01) 67-76
• 10 Turer RW, Gradwohl SC, Stassun J. et al. User-centered design and implementation of an interoperable FHIR application for pediatric pneumonia prognostication in a randomized trial. Appl Clin Inform 2024; 15 (03) 556-568
• 11 Vennemeyer S, Kinnear B, Gao A. et al. User-centered evaluation and design recommendations for an internal medicine resident competency assessment dashboard. Appl Clin Inform 2023; 14 (05) 996-1007
• 12 Kamboj N, Metcalfe K, Chu CH, Conway A. Designing the user interface of a nitroglycerin dose titration decision support system: user-centered design study. Appl Clin Inform 2024; 15 (03) 583-599
• 13 Reno JE, Ong TC, Voong C. et al. Engaging patients and other stakeholders in “designing for dissemination” of record linkage methods and tools. Appl Clin Inform 2023; 14 (04) 670-683
• 14 Greenhalgh T, Abimbola S. The NASSS framework - a synthesis of multiple theories of technology implementation. Stud Health Technol Inform 2019; 263: 193-204
• 15 Miller SD, Murphy Z, Gray JH. et al. Human-centered design of a clinical decision support for anemia screening in children with inflammatory bowel disease. Appl Clin Inform 2023; 14 (02) 345-353