title: Comparing usability testing outcomes and functions of six electronic nursing record systems.
abstract: OBJECTIVE
  This study examined the usability of six differing electronic nursing record (ENR) systems on the efficiency, proficiency and available functions for documenting nursing care and subsequently compared the results to nurses' perceived satisfaction from a previous study.
  
  
  METHODS
  The six hospitals had different ENR systems, all with narrative nursing notes in use for more than three years. Stratified by type of nursing unit, 54 staff nurses were digitally recorded during on-site usability testing by employing validated patient care scenarios and think-aloud protocols. The time to complete specific tasks was also measured. Qualitative performance data were converted into scores on efficiency (relevancy), proficiency (accuracy), and a competency index using scoring schemes described by McGuire and Babbott. Six nurse managers and the researchers completed assessments of available ENR functions and examined computerized nursing process components including the linkages among them.
  
  
  RESULTS
  For the usability test, participants' mean efficiency score was 94.2% (95% CI, 91.4-96.9%). The mean proficiency was 60.6% (95% CI, 54.3-66.8%), and the mean competency index was 59.5% (95% CI, 52.9-66.0). Efficiency scores were significantly different across ENRs as was the time to complete tasks, ranging from 226.3 to 457.2s (χ(2)=12.3, P=0.031; χ(2)=11.2, P=0.048). No significant differences were seen for proficiency scores. The coverage of the various ENRs' nursing process ranged from 67% to 100%, but only two systems had complete integration of nursing components. Two systems with high efficiency and proficiency scores had much lower usability test scores and perceived user satisfaction along with more complex navigation patterns.
  
  
  CONCLUSIONS
  In terms of system usability and functions, different levels of sophistication of and interaction performance with ENR systems exist in practice. This suggests that ENRs may have variable impacts on clinical outcomes and care quality. Future studies are needed to explore ENR impact on nursing care quality, efficiency, and safety.
authors.affiliation: Nursing Department, Inha University, Incheon, South Korea. Electronic address: Insook.cho@inha.ac.kr.
authors.forename: Insook
authors.initials: I
authors.lastname: Cho
authors.affiliation: Department of Nursing, Sunmoon University, Chungnam, South Korea.
authors.forename: Eunman
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Nursing, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Woan Heui
authors.initials: WH
authors.lastname: Choi
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Staggers
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015337:Multicenter Studies as Topic; D009722:Nurse Practitioners / Q000523:psychology* / Q000592:standards; D009737:Nursing Records; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011787:Quality of Health Care; D014584:User-Computer Interface
keywords: Electronic medical record system; Evaluation study; Narrative nursing notes; System usability; User satisfaction