The challenges must be taken seriously
One possible explanation for the higher usability scores reported by GPs is the presence of multiple competing systems within the primary care market. Over time, this may have enabled vendors to tailor functionality and usability to the clearly defined needs of the well-established GP role in Norway.
Hospitals are more complex organisations, with more complicated logistics and a wider range of needs, some of which may be conflicting, across numerous roles. Helseplattformen performs poorly in our survey, and that may be largely attributed to its reliance on rigid, structured data models using SNOMED CT, rather than flexible free-text input (23). This approach was intended to yield benefits through the reuse of structured information. Ensuring that all users uniformly interpret and update the data is difficult and complex. Such precise information management is also time-consuming for the user.
Helseplattformen performs poorly in our survey, and that may be largely attributed to its reliance on rigid, structured data models
Integrating primary care services into the system introduces additional, often conflicting requirements, which may create challenges for users of Helseplattformen. Furthermore, specific issues within the user interface will pose a challenge. Items from the NuHISS method, such as 'The arrangement of fields and functions is logical on the computer screen', 'Routine tasks can be performed in a straightforward manner without the need for extra steps using the system', 'It is easy to obtain necessary patient information using the EHR system', and 'Entering and documenting patient data is quick, easy, and smooth' can help shed light on this (22).
Improved collaboration was supposed to be the main benefit of Helseplattformen, but the system is rated lower than other hospital systems in this regard, and provides few or no benefits for nursing home doctors. This suggests that, in the Norwegian context, an integrated system like Helseplattformen is less effective in supporting collaboration than an ecosystem of EHRs and national interoperability solutions. There is a need to improve digital tools to support collaboration. Despite these challenges, EHRs in Norway perform relatively well by international standards, which may be a reflection of successful national efforts in areas such as electronic messaging, e-prescriptions and the national summary care record.
System owners and decision-makers in regional health authorities, local authorities, government administration and political bodies should familiarise themselves with usability measurement methods and provide for regular evaluations and improvement initiatives. Usability in EHRs must be taken seriously, as it directly impacts patient safety and the sustainability of financial resources and staffing.