A structured framework to improve usability in EHR implementation: a user-centered case study in Brazilian mental healthcare

Background: Electronic Health Record (EHR) systems are central to digital health transformation, yet usability challenges continue to constrain their effectiveness, particularly in mental healthcare contexts. Objectives: To develop and describe a structured, user-centered framework for improving EHR usability based on a Brazilian outpatient mental health case study. Methods: This qualitative design research study, guided by the Double Diamond design methodology, followed four iterative phases (Discover, Define, Develop, Deliver) and conducted qualitative interviews with 21 healthcare professionals. Data were organized using the Certainties, Suppositions, and Doubts (CSD) matrix and triangulated through heuristic evaluation and prototype testing. Results: Key barriers included non-standardized navigation flows, limited integration with external systems, and inflexible documentation structures. Based on these findings, the study proposes design-driven improvements such as customizable templates, real-time validation features, and workflow-specific interface adjustments. Conclusions: By integrating service design logic with usability-driven interface adaptations and addressing both systemic usability gaps and contextual demands, this research contributes actionable insights for advancing human-centered EHR innovation, with particular relevance to complex mental healthcare workflows.