Toward improved heuristic evaluation of EHRs

Electronic Health Records (EHRs) can improve the quality, safety, and efficiency of patient care. Migration to EHRs is progressing, but has been slowed by concerns related to interoperability, security, cost, patient safety, and usability. This paper focuses on EHR usability, specifically heuristic evaluation, or utilizing accepted guidelines for assessing EHR interface design. Health-care researchers initially applied industry-standard heuristics to EHRs, but subsequently health-care-specific groups have adapted and expanded these standard heuristics, calling for development and use of heuristics specific to EHRs. This paper first summarizes the evolution of heuristic evaluation of EHRs, then discusses the similarities and differences between these various approaches. This is an important step in developing community consensus on integrated heuristics, the basis of successful heuristic evaluation of EHRs. We then discuss the 'Theory of Fit' as a means of explaining the existence of these somewhat different heuristics, and close with suggestions for further research.