Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Marlene Dufault


Electronic Health Record (EHR) systems have the potential to be beneficial, but healthcare vendors are challenged to find ways to make them easier to work with and more productive. Systems and tools should be designed to enable nurse-patient engagement, seamlessly fit into practice, and be based on workflow needs. The usability of EHR systems is probably the key factor in making the design of the system fit healthcare providers’ workflow and display patient information clearly. A quantitative descriptive, non-experimental study was conducted to evaluate the usability of a new SmartPhrase interface tool embedded into the Epic EHR system. Twenty-three telephone triage nurses in a multi-site cancer center, located within the largest healthcare system in Rhode Island, were involved in designing and testing the interface tool.

The task of the SmartPhrase tool is to permit quick and easy insertion of pre-texted symptom assessment cues or phrases into a patient’s EHR. The SmartPhrase tool evolved as a basic unit of the Epic EHR in the Lifespan system, specifically as an electronic documentation feature that permits nurses to use pre-formatted text, statements, or structure note templates for cuing documentation. The specific SmartPhrase tool was developed in the context of a larger parent study to improve standardized telephone-triage symptom assessment for cancer patients. Generalized Linear Mixed Model was used to evaluate the usability of an EHR SmartPhrase tool to (1) determine the relationship between telephone triage nurses’ years of experience (in nursing, telephone triage, and oncology) and their perception of the usability of the SmartPhrase tool; (2) assess changes in self-perceived job performance six months following SmartPhrase implementation; and (3) determine the relationship between the telephone triage nurses’ evaluation of the SmartPhrase tool usability and actual tool utilization.

The SmartPhrase tool, as evaluated by telephone triage nurses, was not perceived as particularly useful. Although the usability score was at an acceptable level, this may be indicative of usability problems requiring improvement. The variable contributing to the negative perception was years of oncology experience. The study results supported the premise that whereas high usability would increase self-perceived job performance, low usability would not do so or would decrease job performance. That is, more experienced oncology nurses are less likely to use the SmartPhrase tool. This result is useful and supports findings on fitting technology the workflow task in literature. For a tool to increase job performance, the tool must be highly useful.