From use, value and user-centered design to context: A mixed methods analysis of a hospital electronic medical record enhancement.

Objective: This study sought to determine the use and perceived value of a user-centered electronic medical record (EMR) enhancement for stroke care and understand if its value was in alignment with its intended design. The EMR enhancement was introduced into Queensland public hospitals in Australia and included a summary page for enhanced interprofessional collaboration and data collection forms for efficient data extraction. Methods: A mixed methods design was adopted and data collected from four hospital sites. We conducted 15 semistructured interviews with multidisciplinary end-users across participating sites and analyzed this data using inductive thematic techniques. Usage log data was extracted from the EMR to determine its use. Results: Relative use of the summary page showed moderate use, varying from 66 ± 22.5 uses for each stroke patient admission per month (Site 1) to 26.7 ± 9.1 (Site 2). Interviews identified key themes of "visibility" and providing a "quick snapshot" of patient data as the main positive attributes. Technology "functionality" was perceived negatively. Use of the data collection forms was minimal, with inconsistency across sites: (Site 3, 0% to Site 2, 47%). Negative themes of "inefficiency," poor "functionality" and the "trust" required in data entry practices were found. Conclusions: Despite its user-centered design, clinicians did not always use the enhancement in line with its intended design, or grasp its intended value. Our findings highlight the challenges of user-centered design to accurately reflect clinical workflows within different contexts. A greater understanding is required of how to optimize user-centered EMR design for specific hospital contexts.