Considerations on the Usability of SClínico

  • João Pavão
  • Rute Bastardo
  • Luís Torres Pereira
  • Paula Oliveira
  • Victor Costa
  • Ana Isabel Martins
  • Alexandra Queirós
  • Nelson Pacheco RochaEmail author
Conference paper
Part of the Communications in Computer and Information Science book series (CCIS, volume 1024)


To increase the quality of the health care services and, at the same time, to control their costs, the use of Electronic Health Records (EHR) has substantially increased during the last years. Usability of EHR systems is a key factor to increase their efficiency. The SClínico is an EHR system widely used in public hospitals and primary care centres of the Portuguese National Health Service and the present article reports the assessment of its usability. This usability assessment consisted in three stages: in the first stage, an exploratory assessment was carried out, while in the second stage a quantitative assessment was performed using a validated usability assessment instrument, and, finally, in the third stage a focus group involving clinicians and usability experts was conducted. The results showed that SClínico presents important usability issues and, therefore, recommendations are suggested to overcome the identified issues.


Usability Electronic health record SClínico 



The authors thank the administration board of CHTMAD for all the support provided, as well as all the clinicians of this hospital center who have accepted to participate in the study reported in this article.


  1. 1.
    SPMS: Serviços Partilhados do Ministério da Saúde - SPMS - SClinico Hospitalar. Accessed 17 July 2017
  2. 2.
    SPMS: Serviços Partilhados do Ministério da Saúde - SPMS - SClinico Cuidados Primários. Accessed 17 July 2017
  3. 3.
    Zahabi, M., Kaber, D.B., Swangnetr, M.: Usability and safety in electronic medical records interface design: a review of recent literature and guideline formulation. Hum. Factors 57, 805–834 (2015). Scholar
  4. 4.
    Bhutkar, G., Konkani, A., Katre, D., Ray, G.G.: A review: healthcare usability evaluation methods. Biomed. Instrum. Technol. Suppl. 45–53 (2013). Scholar
  5. 5.
    Pavão, J., et al.: SClinico: usability study. In: Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies, pp. 48–56. SCITEPRESS - Science and Technology Publications (2018)Google Scholar
  6. 6.
    Rouleau, G., Gagnon, M.-P., Côté, J.: Impacts of information and communication technologies on nursing care: an overview of systematic reviews (protocol). Syst Rev. 4, 75 (2015). Scholar
  7. 7.
    Furukawa, M.F., King, J., Patel, V., Hsiao, C.-J., Adler-Milstein, J., Jha, A.K.: Despite substantial progress in EHR adoption, health information exchange and patient engagement remain low in office settings. Health Aff. 33, 1672–1679 (2014). Scholar
  8. 8.
    Marin, H.D.F.: Sistemas de informação em saúde: considerações gerais. J. Health Inform. 2, 20–24 (2010). Scholar
  9. 9.
    Marquié, J.-C.C., Tucker, P., Folkard, S., Gentil, C., Ansiau, D.: Chronic effects of shift work on cognition: findings from the VISAT longitudinal study. Occup Env. Med. 72, 258–264 (2015). Scholar
  10. 10.
    Mair, F.S., May, C., O’Donnell, C., Finch, T., Sullivan, F., Murray, E.: Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bull. World Health Organ. 90, 357–364 (2012). Scholar
  11. 11.
    Kruse, C.S., Kothman, K., Anerobi, K., Abanaka, L.: Adoption factors of the electronic health record: a systematic review. JMIR Med. Inform. 4, e19 (2016). Scholar
  12. 12.
    Kruse, C.S., Kristof, C., Jones, B., Mitchell, E., Martinez, A.: Barriers to electronic health record adoption: a systematic literature review. J. Med. Syst. 40, 252 (2016). Scholar
  13. 13.
    Adler-Milstein, J., Holmgren, A.J., Kralovec, P., Worzala, C., Searcy, T., Patel, V.: Electronic health record adoption in US hospitals: the emergence of a digital “advanced use” divide. J. Am. Med. Inform. Assoc. 24, 1142–1148 (2017). Scholar
  14. 14.
    ISO/IEC 9241-14: ISO/IEC 9241-14: 1998 (E) Ergonomic requirements for office work with visual display terminals (VDT)s – Part 14 Menu dialogue (1998).
  15. 15.
    American Medical Association: Improving Care: Priorities to Improve Electronic Health Record Usability (2014)Google Scholar
  16. 16.
    Feng, R.-C., Chang, P.: Usability of the clinical care classification system for representing nursing practice according to specialty. Comput. Inform. Nurs. 33, 448–455 (2015)CrossRefGoogle Scholar
  17. 17.
    Villa, L.B., Cabezas, I.: A review on usability features for designing electronic health records. In: 2014 IEEE 16th International Conference on e-Health Networking, Applications and Services, HealthCom 2014, pp. 49–54 (2015)Google Scholar
  18. 18.
    Choi, M., Lee, H.S., Park, J.H.: Usability of academic electronic medical record application for nursing students’ clinical practicum. Health Inf. Res. 21, 191–195 (2015). Scholar
  19. 19.
    Czaja, S.J., Zarcadoolas, C., Vaughon, W.L., Lee, C.C., Rockoff, M.L., Levy, J.: The usability of electronic personal health record systems for an underserved adult population. Hum. Factors 57, 491–506 (2015). Scholar
  20. 20.
    Clarke, M.A., Belden, J.L., Kim, M.S.: Determining differences in user performance between expert and novice primary care doctors when using an electronic health record (EHR). J Eval Clin Pr. 20, 1153–1161 (2014). Scholar
  21. 21.
    Johnston, D., Crowle, P.K.: EHR usability toolkit: a background report on usability and electronic health records. Agency for Healthcare Research and Quality, Rockville (2011)Google Scholar
  22. 22.
    Zhang, J., Walji, M. (eds.): Better EHR: Usability, Workflow and Cognitive Support in Electronic Health Records. National Center for Cognitive Informatics & Decision Making in Healthcare (2014). ISBN: 978-0-692-26296-2Google Scholar
  23. 23.
    Saitwal, H., Feng, X., Walji, M., Patel, V., Zhang, J.: Assessing performance of an electronic health record (EHR) using cognitive task analysis. Int J Med Inf. 79, 501–506 (2010). Scholar
  24. 24.
    Edwards, P.J., Moloney, K.P., Jacko, J.A., Sainfort, F.: Evaluating usability of a commercial electronic health record: a case study. Int. J. Hum Comput Stud. 66, 718–728 (2008). Scholar
  25. 25.
    Middleton, B., et al.: Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J. Am. Med. Inform. Assoc. 20, e2–e8 (2013). Scholar
  26. 26.
    Lowry, S.Z., et al.: Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records (2012)Google Scholar
  27. 27.
    Martins, A.I.., Queirós, A.., Silva, A.G.., Rocha, N.P.: Usability evaluation methods: a systematic review. In: Human Factors in Software Development and Design, pp. 250–273 (2014)Google Scholar
  28. 28.
    Rosa, A., Martins, A., Costa, V., Queiros, A., Silva, A., Rocha, N.: European Portuguese validation of the post-study system usability questionnaire (PSSUQ). In: 2015 10th Iberian Conference on Information Systems and Technologies (CISTI), pp. 1–5 (2015)Google Scholar
  29. 29.
    Lewis, J.: Psychometric evaluation of the PSSUQ using data from five years of usability studies. Int. J. Hum. Comput. Interact. 14, 463–488 (2002). Scholar
  30. 30.
    Covêlo, M.: Interface para Aplicação Informática de Suporte Clínico em Ambiente Hospitalar (2016).
  31. 31.
    Wilkinson, S.: A practical guide to research methods. In: Smith, J. (ed.) Qualitative Psychology: A Practical Guide to Research Methods. SAGE Publications (2003)Google Scholar
  32. 32.
    Caplan, S.: Using focus group methodology for ergonomic design. Ergonomics 33, 527–533 (1990). Scholar
  33. 33.
    World Medical Association: Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects (2013)Google Scholar
  34. 34.
    International Epidemiological Association: Good Epidemiological Practice (GEP). IEA Guidelines for Proper Conduct in Epidemiologic Research. Accessed 13 June 2018
  35. 35.
    Pavão, J., et al.: Usability study of SClinico. In: 2016 11th Iberian Conference on Information Systems and Technologies (CISTI), pp. 1–6 (2016)Google Scholar
  36. 36.
    Yan, R.: Icon design study in computer interface. Procedia Eng. 15, 3134–3138 (2011). Scholar
  37. 37.
    Elam, K.: Grid Systems: Principles of Organizing Type. Princeton Architectural Press, New York (2004)Google Scholar
  38. 38.
    Lupton, E., Phillips, J.C.: Graphic Design: The New Basics. Princeton Architectural Press, New York (2008)Google Scholar
  39. 39.
    Hansen, D., Shneiderman, B., Smith, M.A.: Analyzing Social Media Networks with NodeXL: Insights from a Connected World (2010)Google Scholar
  40. 40.
    Behler, R.: Military Healthcare System (MHS) GENESIS Initial Operational test and Evaluation (IOT&E) Report (2018). Accessed 17 July 2018

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Science and Technology School, INESC-TECUniversity of Trás-os-Montes and Alto DouroVila RealPortugal
  2. 2.Science and Technology SchoolUniversity of Trás-os-Montes and Alto DouroVila RealPortugal
  3. 3.Centre for the Research and Technology of Agro-Environmental and Biological Sciences, CITABUniversity of Trás-os-Montes and Alto DouroVila RealPortugal
  4. 4.Centro Hospitalar of Trás-os-Montes e Alto DouroVila RealPortugal
  5. 5.IEETAUniversity of AveiroAveiroPortugal
  6. 6.Health Sciences School, IEETAUniversity of AveiroAveiroPortugal
  7. 7.Department of Medical Sciences, IEETAUniversity of AveiroAveiroPortugal

Personalised recommendations