BACKGROUND: A growing body of literature has linked usability limitations within electronic health records (EHRs) to adverse outcomes which may in turn affect EHR system transitions. NewYork-Presbyterian Hospital (NYP), Columbia University College of Physicians and Surgeons (CU) and Weill Cornell Medical College (WC) are a tripartite organization with large academic medical centers that initiated a phased transition of their EHRs to one system, EpicCare©. OBJECTIVES: To characterize usability perceptions stratified by provider roles by surveying WC ambulatory clinical staff already utilizing EpicCare© and CU ambulatory clinical staff utilizing iterations of Allscripts© before the implementation of EpicCare© campus-wide. METHODS: A customized 19-question electronic survey utilizing usability constructs based on the Health Information Technology Usability Evaluation Scale was anonymously administered prior to EHR transition. Responses were recorded with self-reported demographics. RESULTS: 1,666 CU and 1,065 WC staff with ambulatory self-identified work setting were chosen. Select demographic statistics between campus staff were generally similar with small differences in patterns of clinical and EHR experience. Results demonstrated significant differences in EHR usability perceptions among ambulatory staff based on role and EHR system. WC staff utilizing EpicCare© accounted for more favorable usability metrics than CU across all constructs. Ordering providers (OPs) denoted less usability than non-OPs. The Perceived Usefulness and User Control constructs accounted for the largest differences in usability perceptions. The Cognitive Support and Situational Awareness construct was similarly low for both campuses. Prior EHR experience demonstrated limited associations. CONCLUSIONS: Usability perceptions can be affected by role and EHR system. OPs consistently denoted less usability overall and were more affected by EHR system than non-OPs. While there was greater perceived usability for EpicCare© to perform tasks related to care coordination, documentation and error prevention, there were persistent shortcomings regarding tab navigation and cognitive burden reduction, which have implications on provider efficiency and wellness.

Background: The 21st Century Cures Act mandates sharing electronic health records (EHRs) with patients. Healthcare providers must ensure confidential sharing of medical information with adolescents while maintaining parental insight into adolescent health. Given variability in state laws, provider opinions, EHR systems and technological limitations, consensus on best practices to achieve adolescent clinical note sharing at scale is needed. Objectives: To identify an effective intervention process to implement adolescent clinical note sharing, including ensuring adolescent portal account registration accuracy, across a large multihospital healthcare system comprising inpatient, emergency, and ambulatory settings. Methods: A query was built to assess portal account registration accuracy. At a large multihospital healthcare system, 80.0% of 12 to 17-year-old patient portal accounts were classified as inaccurately registered (IR) under a parent or registration accuracy unknown (RAU). To increase accurately registered (AR) accounts, the following interventions were pursued: 1)distribution of standardized portal enrollment training; 2) patient outreach email campaign to re-register 29,599 portal accounts; 3) restriction of access to remaining IR and RAU accounts. Proxy portal configurations were also optimized. Subsequently, adolescent clinical note sharing was implemented. Results: Distribution of standardized training materials decreased IR and increased AR accounts (p=0.0492 & 0.0058, respectively). Our email campaign (response rate: 26.8%) was most effective in decreasing IR and RAU accounts and increasing AR accounts (p<0.002 for all categories). Remaining IR and RAU accounts, 54.6% of adolescent portal accounts, were subsequently restricted. Post-restriction, IR accounts continued declining significantly (p=0.0056). Proxy portal enhancements with interventions deployed increased proxy portal account adoption. Conclusions: A multi-step intervention process can be utilized to effectively implement adolescent clinical note sharing at a large scale across care settings. Improvements to EHR technology, portal enrollment training, adolescent/proxy portal settings, detection and automation in re-enrollment of inaccurate portal accounts are needed to maintain integrity of adolescent portal access.