By Hwayoung Cho, PhD, RN
Have you ever clicked the wrong button in an electronic health record, hesitated while using a mobile health app, or struggled to find the right field in another clinical system? Or maybe you’ve paused for a moment while programming a smart infusion pump, unsure which button to press. Those moments are more than annoyances — they’re usability problems in health technology.
Usability determines how easily a person can use technology to accomplish their goals safely and efficiently. In health care, where every second counts, poor usability can lead to errors, stress and even harm. At the University of Florida College of Nursing, our faculty and students are tackling these challenges by studying how users — nurses and other clinicians — interact with health technology and how thoughtful design can better support care.
When Design Goes Wrong
The U.S. Food and Drug Administration recognizes that many “use errors” stem from design problems rather than user mistakes. Poor interface design, ambiguous buttons or inconsistent layouts can easily lead to clinical mistakes.
Think about a medical device interface or a documentation template that requires extra clicks or unclear confirmations. When time is tight, even a moment of hesitation or uncertainty can have serious consequences. See the figure below — which blue button would you push?
Figure 1. “Push the blue button”: an everyday usability hazard
Conceptual illustration showing how unclear control design can cause user hesitation and increase the risk of error (created by Dr. Cho).
Inconsistent visual cues, such as color, can also contribute to use error. See Figure 2.
Figure 2. Reversed color coding: another example of a usability hazard
Illustration showing how inconsistent color use can confuse users and increase the risk of error (created by Dr. Cho).
These design flaws remind us that technology is only as safe as it is usable.
What is usability and how do we measure it?
Usability comes from the field of human-computer interaction, or HCI — the study of how people interact with technology to accomplish work. In health care, usability reflects the quality of interaction between nurses and technology — how effectively that interaction supports safe, efficient and confident completion of clinical tasks.
According to the International Organization for Standardization (ISO 9241-11), usability is “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use.” This framework defines the context of use as the user, task, equipment and environment — all of which influence how a product supports goal achievement.
Usability, therefore, is not only about design simplicity but about how well the system performs within the realities of practice.
Building on these concepts, the stratified usability evaluation framework (Cho et al., Journal of Biomedical Informatics, 2018) categorizes evaluation methods into three levels:
A nurse’s (user’s) interaction with an EHR or other health technology (system) to complete a clinical task (task) in a busy unit (environment) will differ in usability from that of a nurse in another context.
Seeing through the eyes of the user
In usability testing, participants often “think aloud” as they interact with a system. But what if we could literally see what they see? In a study published in the International Journal of Medical Informatics (2019), Dr. Cho and colleagues combined eye-tracking with retrospective think-aloud methods.
Participants used a mobile health app while their eye movements — fixations, gaze paths and revisits — were recorded. They then reviewed their own eye-tracking videos and described what they were thinking during moments of hesitation or error.
This approach provided both objective data (where users actually looked) and subjective insights (why they did it), offering a deeper understanding of user behavior and interface design.
Figure 3. Eye-tracking gaze plot and heat map
The gaze plot (left) shows users’ visual paths and fixation points. The heat map (right) highlights areas of highest attention in red, revealing usability issues and navigation challenges.
Why nurses should care about usability in health technology
Usability in health technology is not just a technical issue — it’s a nursing issue. When systems are intuitive, nurses save time, reduce errors and feel more confident. When systems are cumbersome, frustration and burnout rise (Cho et al., Journal of the American Medical Informatics Association, 2024).
Nurses are both end users and change agents who can advocate for better design and improved usability. By engaging in usability evaluation, nurses ensure technology supports — not complicates — safe, high-quality care.
Practical ways nurses can engage in usability
You don’t need to be a usability expert to make a difference. Nurses play a critical role in identifying and improving technology design by sharing their real-world insights:
- Provide end-user feedback: Report confusing screens, missing data fields or extra clicks that slow workflow.
- Participate in usability testing: Volunteer to test new EHR features or mobile tools and describe what works — or doesn’t.
- Join implementation or informatics committees: Advocate for design changes that reflect nursing workflow.
- Collaborate with informatics specialists: Partner with researchers or IT teams who conduct formal usability studies to ensure nursing perspectives are represented.
- Educate peers and students: Discuss how system design affects safety, communication and satisfaction in everyday practice.
The future of usability in nursing
Emerging AI and digital technologies make usability evaluation more urgent than ever. Health technologies that are not designed with nurses in mind risk widening the gap between innovation and care. That’s why our research continues to explore user-centered evaluation methods, interdisciplinary collaboration and educational integration. We’re building a generation of nurses who don’t just use technology — they improve it.
At FloGatorAI, we invite you to join the conversation. How has usability in health technology — good or bad — impacted your practice? Share your experiences and help us design a health care future that truly sees through the eyes of the user.