The Electronic Health Record in Ophthalmology: Usability Evaluation Tools for Health Care Professionals

INTRODUCTION: The adoption of the electronic health record (EHR) has grown rapidly in ophthalmology. However, despite its potential advantages, its implementation has often led to dissatisfaction amongst health care professionals (HCP). This can be addressed using a user centred design (UCD) which is based on the philosophy that ‘the final product should suit the users, rather than making the users suit the product’. There is often no agreed best practice on the role of HCPs in the UCD process. In this paper, we describe practical qualitative methodologies that can be used by HCPs in the design, implementation and evaluation of ophthalmology EHRs. METHODS: A review of current qualitative usability methodologies was conducted by practising ophthalmologists who are also qualified health informaticians. RESULTS: We identified several qualitative methodologies that could be used for EHR evaluation. These include: 1. Tools for user centred design: shadowing and autoethnography, semi-structured interviews and questionnaires. 2. Tools for summative testing: card sort and reverse card sort, retrospective think aloud protocol, wireframing, screenshot testing and heat maps. CONCLUSION: High-yield, low-fidelity tools can be used to engage HCPs with the process of ophthalmology EHR design, implementation and evaluation. These methods can be used by HCPs without the requirement for prior training in usability science, and by clinical centres without significant technical requirements.