The Impact of Electronic Health Record System Design Factors on Medication-Related Clinical Decisions in the UK Hospital Setting: A Multiple-Methods Study

Abstract

Background: Electronic health record (EHR) systems are widely used across the UK. However, the impact of EHR design on prescribing decisions remains understudied. Aim: To explore how EHR design factors affect prescribing decisions in two UK hospitals and identify knowledge gaps and areas for improvement. Method: First, a systematic review was conducted to explore the impact of EHR design factors on prescribing decision-making, highlighting gaps and key areas for further research. Next, a comparative study examined the impact of different designs of a paediatric sepsis screening tool (PSST) on antimicrobial prescribing for suspected sepsis. This was followed by a survey-based study evaluating user awareness, usability, and satisfaction with the PSST. Finally, multi-site semi-structured interviews with hospital prescribers using well-established commercial EHR systems were conducted to explore how EHR designs influence prescribing decision-making. Results: The systematic review identified key factors of EHR systems that could influence prescribing decision-making. The comparative study found that the locally developed PSST negatively impacted sepsis screening, prescribing time, documentation, and length of stay. Several potential design flaws/factors within the PSST were identified as possible contributors to these findings. Doctors reported lower awareness, usage, training, usability, and satisfaction with the PSST compared to nurses. The interviews identified three key factors—system, user, and environment—that were perceived to influence prescribing decisions. Hospital prescribers expressed that involving them in EHR design could improve usability and acceptance. Conclusion: EHR design has a complex impact on influencing prescribing decisions, clinical workflows and patient care. Poorly designed systems can hinder workflows, leading to low usage and user frustration. End-users demonstrate different design preferences based on their profession. These findings emphasise the need for user-centred design, ongoing feedback, and regular updates to meet users’ evolving needs. Addressing these factors may enhance prescribers' decision-making, satisfaction, trust, and quality of care.