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Appl Clin Inform 2025; 16(04): 760-768
DOI: 10.1055/a-2576-1596
Research Article

Lessons Learned from the Usability Assessment of an EHR-Based Tool to Support Adherence to Antihypertensive Medications

Safa Elkefi
1   School of Nursing Columbia University, New York, New York, United States
2   NYU Langone Health, Institute for Excellence in Health Equity, New York, New York, United States
3   Department of Applied Computing, Michigan Technological University, Houghton, Michigan, United States
,
Tiffany R. Martinez
4   Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States
,
Talia Nadel
4   Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States
,
Antoinette M. Schoenthaler
2   NYU Langone Health, Institute for Excellence in Health Equity, New York, New York, United States
4   Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States
5   Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States
,
Devin M. Mann
4   Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States
5   Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States
6   Medical Center Information Technology, NYU Langone Health, New York, New York, United States
,
Saul Blecker
4   Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States
5   Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States
› Author Affiliations
Funding This study was supported by the National Heart Lung and Blood Institute under the award number: 1R01HL156355-01. The content is solely the authors' responsibility and does not necessarily represent the official views of the National Institute of Health.
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Abstract

Background/Objective

Uncontrolled hypertension is common and frequently related to inadequate adherence to prescribed medications, resulting in suboptimal blood pressure control and increased healthcare utilization. Although healthcare providers have the opportunity to improve medication adherence, they may lack the tools to address adherence at the point of care. This study aims to assess the usability of a digital tool designed to improve medication adherence and blood pressure control among patients with hypertension who are not adherent to therapy. By evaluating usability, the study seeks to refine the tool's design, underscore the role of technology in managing hypertension, and provide insights to inform clinical decisions.

Methods

We performed qualitative usability testing of an electronic health record (EHR)-integrated intervention with medical assistants (MAs) and primary care providers (PCPs) from a large integrated health system. Usability was assessed with these end-users using the “think aloud” and “near live” approaches. This evaluation was guided by two frameworks: the End-User Computing Satisfaction Index (EUCSI) and the Technology Acceptance Model (TAM). Interviews were analyzed using a thematic analysis approach.

Results

Thematic saturation was reached after usability testing was performed with 10 participants, comprising 5 PCPs and 5 MAs. The study identified several strengths within the content, format, ease of use, timeliness, accuracy, and usefulness of the tool, including the user-friendly content presentation, the usefulness of adherence information, and timely alerts that fit into the workflow. Challenges centered around alert visibility and specificity of information.

Conclusion

Leveraging the two conceptual frameworks (TAM and EUCSI) to test the usability of the medication adherence tool was helpful. The tool's several strengths and opportunities for improvement were found. The resulting suggestions will be used to support the enhancement of the design for optimal implementation in a clinical trial.

Keywords

usability - medication adherence - clinical workflow - EHR - clinical information systems - burnout

Protection of Human and Animal Subjects

The studies involving humans were approved by the New York University IRB office (IRB ID 21–00133). The confidentiality of participants is fully protected as per the IRB requirements.


Supplementary Material



Publication History

Received: 11 November 2024

Accepted: 05 April 2025

Article published online:
14 August 2025

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