Violent video games, Explicit lyrics and the Usability of Health IT

Back in the 1980s Tipper Gore. Susan Baker, and several others created the Parents Music Resource Center (PMRC) with the intent of increasing parental control over the access of children to music deemed to have violent, drug-related or sexual themes. They used their influence as “Washington Wifes” to push for regulation of the music industry. By 1985, 19 record companies agreed to put "Parental Guidance: Explicit Lyrics" labels on albums to warn consumers of explicit lyrical content.

The Entertainment Software Rating Board (ESRB) assigns age and content ratings to consumer video games. The ESRB was established in 1994 by the Entertainment Software Association in response to criticism of controversial video games with excessively violent or sexual content.

Although controversial, both the music and video game industries have been able to self-regulate and voluntarily provide information to consumers about the content of their respective media.

In a recent report published by JAMA (Howe JL ; Adams KT ; Hettinger AZ; et al. Electronic health record usability issues and potential contribution to patient harm. JAMA. 2018; 319: 1276-1278) researchers analyzed voluntary error reports associated with Electronic Health Record (EHR) systems and found that problems with EHR usability may have directly resulted in patient harm.

As part of the Meaningful Use (Stage 2) program EHR vendors were required to conduct and report on the usability of their system. Over 4000 EHRs were certified for the 2014 Edition certification.

EHR vendors are required to conduct and report on a summative usability evaluation of their system as part of the ONC 2015 Edition Certification(s) for Safety-Enhanced Design (§170.315.g.3). The ONC certification is associated with the MIPS/MACRA funding model with a deadline of January 2019 to avoid a reduction of payments to providers that are using a system that is not ONC 2015 Edition certified, but as of April 2018 only 162 products are listed as 2015 Edition certified on the Certified Health IT Products List.

This means that Ninety-six (96) percent of the electronic record systems that were 2014 certified are not yet certified to the 2015 Edition usability standard. Usability (or lack thereof) has been a topic of discussion for way too long and the time for action is now. Government regulation isn’t working and people are dying because of medical errors caused by a less than optimal user experience on software designed for healthcare providers.

More than ninety (90) percent of doctors are using EHRs but only four (4) percent are EHRs that are 2015 Edition certified for Safety-enhanced Design (aka Usability).

Think about this: Many companies spend more on documentation, training and support because of a design flaw than what it would cost to discover and fix an underlying usability issue.

The Electronic Healthcare Records Association (EHRA) has made several great first steps in promoting Healthcare Usability across it’s 30 or so members. But now is time for the Healthcare Usability Community to get together and create its own infrastructure, ratings and guidelines to improve the usability of all EHRs.

We propose putting together a panel of HealthIT Usability Professionals to create a set of voluntary EHR usability guidelines that supersedes the ONC requirements and a public facing HealthIT rating system that is outside the government regulatory framework. The music industry did it, the videogame industry did it, so can we. Let’s get together and promote the safe use of Health IT.

Usability in HealthIT saves lives. (and a lot of money).


The Usability People work with you on improving the Usability of Healthcare IT.

For expert 2015 ONC Safety-enhanced Design (aka Usability) evaluation of your EHR: contact The Usability People

The Usability People

Together we may save a life! #SafeHealthIT