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.

Publication History

Received: 27 October 2024

Accepted: 11 March 2025

Accepted Manuscript online:
12 March 2025

Article published online:
02 July 2025

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