EHR usability is the extent to which EHR can be used by providers to achieve specific goals efficiently and effectively leading to fewer clinicians’ burnout, fewer medical errors, less alert fatigue, improved patient safety, greater user satisfaction, and consequently higher EHR-related productivity.
As an aspiring healthcare manager, you need to determine the usability of EHR and seek a grant for this research. The research proposal should include five parameters: effectiveness (task completion), efficiency (time of task completion), satisfaction (task rating), alert (pointing errors), and reminders (follow-up). For this assignment design a survey using Survey Monkey or any other applications to attain this information on a 5-point Likert Scale (1- Strongly Disagree, 2-Disagree, 3- Neutral, 4- Agree, 5- Strongly Agree) and explain:
If the number of users is 1000 but you had limited resources, what is (%) minimal of the employees would you select for this survey to ensure representation of the user (offer supporting arguments)?
Which of the three research methods (personal interviews, mail-in paper forms, email-embedded survey link) of obtaining this information would you use (offer rationale)?
Which statistical method would you use to determine whether the means of these five Likert Scale groups are significantly different from one another and why?
If the means of any of these Likert Scale groups were not statistically different from each other, but still different, what would be your interpretation of the variations?
Full Answer Section
- I can effectively manage patient orders and prescriptions through the EHR. (1-5)
Section 2: Efficiency (Time of Task Completion)
- Using the EHR saves me time compared to paper-based systems. (1-5)
- I can complete tasks quickly and efficiently within the EHR. (1-5)
- The EHR's interface is intuitive and easy to navigate. (1-5)
- I experience minimal delays or slowdowns while using the EHR. (1-5)
- The EHR streamlines my workflow. (1-5)
Section 3: Satisfaction (Task Rating)
- I am satisfied with the overall usability of the EHR. (1-5)
- The EHR is user-friendly. (1-5)
- I find the EHR easy to learn and use. (1-5)
- I would recommend this EHR to other healthcare providers. (1-5)
- I am comfortable using the EHR. (1-5)
Section 4: Alerts (Pointing Errors)
- The EHR's alert system is helpful in preventing errors. (1-5)
- I receive too many unnecessary alerts (alert fatigue). (1-5)
- The alerts are clear and easy to understand. (1-5)
- The EHR's alert system helps improve patient safety. (1-5)
- I can easily manage and customize the EHR's alerts. (1-5)
Section 5: Reminders (Follow-up)
- The EHR's reminder system is effective for patient follow-up. (1-5)
- I can easily set and manage reminders within the EHR. (1-5)
- The reminders help me improve patient care. (1-5)
- The EHR's reminder system is integrated well into my workflow. (1-5)
- I am satisfied with the EHR's reminder functionality. (1-5)
Demographics (Optional but Recommended):
- Role (e.g., physician, nurse, administrative staff)
- Years of experience using EHRs
- Department
Addressing Your Questions:
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Minimal Sample Size: For a population of 1000 users, a sample size of at least 278 would be statistically significant at a 95% confidence level with a 5% margin of error. This is calculated using a sample size calculator, readily available online. However, given limited resources, you could consider a slightly smaller sample size (e.g., 200-250) while acknowledging the slightly reduced precision. It's crucial to emphasize the importance of random sampling to ensure the selected users represent the entire user base. Stratified sampling (e.g., by role) could further improve representation.
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Research Method: An email-embedded survey link would be the most efficient and cost-effective method for this large sample size. It allows for easy distribution, automated data collection, and reduces the burden on researchers. While personal interviews provide richer qualitative data, they are resource-intensive. Mail-in surveys have low response rates and are slow.
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Statistical Method: A Kruskal-Wallis test would be appropriate to determine if there are statistically significant differences among the means of the five Likert scale groups. Since Likert scale data is ordinal (the intervals between points may not be equal), a non-parametric test like Kruskal-Wallis is preferred over ANOVA. If the Kruskal-Wallis test is significant, post-hoc tests (e.g., Dunn's test) can be used to determine which specific groups differ significantly from each other.
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Interpreting Non-Significant but Different Means: If the means of some Likert scale groups are not statistically different, it suggests that, while there are apparent differences in the average scores, these differences are likely due to chance and not a true effect of the EHR. However, it's essential to consider the magnitude of the differences. Even if not statistically significant, a noticeable difference in means (e.g., a 0.5-point difference on the Likert scale) might still be clinically meaningful and warrant further investigation, especially if it aligns with qualitative feedback or other data. It could also indicate the sample size was not large enough to detect a statistically significant difference (Type II error). Further research with a larger sample might be needed. Additionally, it's crucial to review the distribution of responses within each group. Even if the means are similar, the spread of responses could reveal important variations in user experience.
Sample Answer
Here's a proposed approach to assessing EHR usability, including a sample survey and answers to your specific questions.
Sample EHR Usability Survey (using a 5-point Likert Scale):
Section 1: Effectiveness (Task Completion)
- I can easily complete patient documentation tasks using the EHR. (1-5)
- The EHR helps me accurately record patient information. (1-5)
- I can efficiently find the information I need in the EHR. (1-5)
- The EHR supports my clinical decision-making. (1-5)