The digitalisation of healthcare has long been promoted as a pathway to safer, more efficient clinical practice, with electronic medical records (EMRs) positioned as a central component of this transformation. In Switzerland, as in many European countries, hospitals are upgrading from older EMR systems to more advanced platforms. However, a recent national survey of Swiss physicians indicates that these systems often fall short of their intended benefits. The findings raise critical concerns about usability, patient safety and efficiency, with many clinicians expressing dissatisfaction with the tools they are expected to rely on daily.
Systemic Usability Issues in Clinical Practice
Across a representative sample of 1,933 physicians, more than half reported that their EMR did not enhance patient safety, and a similar proportion felt it failed to support efficient work. On average, EMRs achieved just over 50 percent of the maximum usability score, suggesting widespread shortcomings. The study used validated instruments such as the SURE (System Usability and Risk Evaluation) scale and the SES (Safety, Efficiency, Satisfaction) score to assess key aspects of usability. These included integration into workflow, navigation, cognitive workload and the effectiveness of alerts.
Hospital physicians reported particularly negative experiences, with two thirds stating that EMR inefficiency caused daily time loss. Only a minority believed their systems effectively helped prevent errors in care. Physicians in outpatient settings, while still critical, gave higher usability ratings. This contrast indicates that the context in which EMRs are implemented plays a major role in shaping user experience. The most common complaints focused on long loading times, excessive and poorly designed alerts, and insufficient support for task prioritisation and decision-making.
Physicians’ perceptions were shaped by how well systems aligned with their everyday clinical responsibilities. Items that received the lowest ratings included support for collaboration with external colleagues and prevention of data entry errors. On the other hand, remembering how to use the system and collaboration with internal colleagues were rated more favourably. These variations demonstrate that even within a broadly negative assessment, certain elements perform better than others, offering a direction for focused improvement.
Influence of Setting, Implementation and Training
The survey found that EMR usability is not determined by the software alone. A significant portion of the variation in ratings was linked to how each EMR was implemented at the institutional level. Over half of the variance in usability scores could be attributed to differences between hospital sites using the same EMR. This finding suggests that local factors, such as configuration choices and user support from hospital IT departments, are pivotal in shaping clinicians’ experience.
Three EMRs commonly used in hospitals were compared in detail, revealing distinct usability profiles. Features such as system responsiveness, clarity of information display and internal collaboration tools helped distinguish the systems. The results indicate that clinicians are not indiscriminately negative about EMRs but are responding to specific performance issues.
Training also played a critical role. Physicians who received either no training or more than 16 hours of training reported lower satisfaction than those with moderate levels of instruction. This could reflect a mismatch between training content and practical needs. Similarly, experience with the system mattered: those with more than one year of EMR use tended to report greater satisfaction, possibly because of greater familiarity or adaptation to the system’s limitations.
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Differences also emerged between specialties. Anaesthesiologists and intensive care physicians, who typically work in high-pressure environments, were among the least satisfied groups. This aligns with the notion that EMRs often fail to meet the needs of clinicians dealing with urgent, complex care. These groups may require systems that support rapid decision-making and minimise cognitive load, yet they often experience the opposite.
Towards More Usable and Safer EMRs
Despite the disappointing overall picture, the study offers insights that could inform future improvements. Comparative assessments of EMR usability can help guide procurement decisions, support system refinements and highlight best practices. By identifying which features contribute most to user dissatisfaction, hospitals and vendors can target enhancements more precisely.
The high predictive accuracy of the SURE scale in distinguishing between EMRs suggests it could be used as a benchmarking tool. Its use could foster greater transparency and enable healthcare providers to hold developers accountable. However, developers are not solely responsible. The hospital IT environment and its collaboration with clinical users are equally important. Efforts to improve usability should therefore be co-produced by vendors, IT teams and frontline clinicians.
Research has shown that targeted usability improvements, such as redesigning alert systems or streamlining access to test results, can lead to better outcomes. These types of focused interventions should become standard practice during EMR implementation or updates. In publicly funded health systems, where EMRs represent major capital investments, rigorous evaluation of usability and its impact on patient safety is essential.
EMRs are meant to support clinicians in delivering safe and efficient care, but current systems often fall short of that goal. In Switzerland, physicians report widespread dissatisfaction with EMRs, especially in hospital settings. The variation in usability scores between systems and institutions shows that improvement is possible but will require targeted action. Effective collaboration between healthcare providers, IT departments and software vendors is key to making EMRs work for those who rely on them. Usability must become a central criterion in both procurement and system evaluation if the promise of digital health is to be fulfilled.
Source: npj digital medicine
Image Credit: iStock
