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

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

Objective: 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 one-year period, physician volunteers were given access to a position within the EHR where new features were available for testing before widespread deployment. Real-time feedback was obtained through a shared platform with institutional IS support leaders and 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 features during real-world clinical work at their discretion. Feedback was given via a Teams chat function resulting in 1024 messages from 28 users over a one- 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 2 required additional changes to improve functionality prior to implementation. The majority found this method intuitive and effective in testing new EHR features.

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