Clinical System Evaluation Checklist
Evaluate a clinical system’s usability, functionality, workflow fit, and follow-up needs using this review form.
Evaluator and System Details
Evaluator Name
*
Evaluator Role / Title
*
Department / Team
System Name Being Evaluated
*
System Version / Build
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Functionality and Usability Evaluation
Overall Functionality Rating
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Usability Rating
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Workflow Fit Rating
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Observed Strengths / Working Areas
Fast response time
Intuitive navigation
Clear clinical screens
Reliable data entry
Helpful alerts and reminders
Good integration with existing workflow
Other
Issues / Gaps Found
Slow performance
Confusing navigation
Missing clinical fields
Alert overload
Integration problems
Difficult data entry
Inconsistent output/reporting
Other
Final Review and Follow-up
Overall Recommendation
*
Approve
Approve with Changes
Needs Review
Not Recommended
Prioritized Follow-up Actions
Additional Comments or Notes
Submit Evaluation
Should be Empty: