Can clinicians create high-quality databases: a study on a flexible electronic health record (fEHR) system

Clinicians are becoming increasingly dependent on health information technologies (HIT) in their daily activities, like data collection. However, currently, most HITs are vendor designed systems, which are often inconsistent and inflexible with respect to the needs of the clinicians. Consequently, time and again, the HITs are found to be unfit for the healthcare workflow. A better HIT design is to empower the clinicians with the ability to modify system functionality as per their needs. In this paper, we propose a flexible Electronic Health Record (fEHR) system, which allows clinicians to build new templates/forms for data collection over an existing EHR system through a user interface. The system automatically translates the forms to underlying databases while shielding the user from knowing the technical details. A key contribution is that the generated databases are high-quality with desirable properties. To test the system usability, we conducted a user study with clinicians working in a nurse-managed health services center. The participants performed the given tasks with 100% effectiveness, within a short span of time, in all but one case; and exhibited an improvement in their understanding of the system. Our study demonstrates that the fEHR system has the potentials of incorporating flexibility into HITs to make them more effective and efficient for healthcare. We show that the fEHR is a favorable environment for clinicians to develop and improve their need-modeling skills.