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www.MedicalHumanFactors.net www.MedicalHumanFactors.net
Realizing the potential of improving care and continuous learning: USER CENTERED DESIGN
LEADERSHIP CONSORTIUM FOR A VALUE & SCIENCE-DRIVEN HEALTH SYSTEM Digital Learning Collaborative, National Academy of Medicine: December 1, 2016
Rollin J. (Terry) Fairbanks, MD, MS Director, National Center for Human Factors Engineering in Healthcare
Associate Director, MedStar Institute for Innovation MedStar Health, Washington DC, USA
Associate Professor of Emergency Medicine, Georgetown University Attending Emergency Physician, MedStar Washington Hospital Center
@TerryFairbanks
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What is Human Factors Engineering?
…discovers and applies scientific data about human
behavior & cognition,
abilities & limitations,
physical traits,
and other characteristics
…to the design of
tools & machines,
systems,
environments,
processes,
and jobs
for productive, safe, comfortable, and effective human use.
--Sarah Henrickson Parker, PhD
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Human Factors Engineering
“We don’t redesign humans; We redesign the system within which humans work”
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The Two Bins of Usability
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1: User Interface Design Context Independent
Displays and Controls
Screen Design Clicks & Drags
Colors & Navigation
The Two Bins of Usability
2: Cognitive Task Support
Context Dependent
“Workflow Design” Smart Data Visualization Support Cognitive Work
Functionality
Photo credit to Bob Wears, MD, PhD
www.MedicalHumanFactors.net http://www.himss.org/ValueSuite Photo credit to Bob Wears, MD, PhD
Bin 1 –User Interface (UI)
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1
Bin 2- basic
1
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Bin 2 - Basic
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Bin 2 – Advanced
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Usability and User Centered Design • 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
• Usability is measurable
• User centered design is a process for developing usable systems
ISO 3407
Understand and specify the
context of use
Specify the user and organizational
requirements
Produce design solutions
Evaluate design against
requirements
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What user-centered design is NOT
• Simply having physician/nurse on design team
• Advisory Board
• Focus Groups
• Isolated, late stage summative testing
• Guidance for training design
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EHR Vendor UCD Processes
•Focused on customer requests
•Responding to user feedback is UCD
•No formalized method for incorporating and testing user needs throughout design and development
No True UCD
•Understand UCD and its importance
•Striving to implement UCD processes
•UCD is not fully integrated yet
Basic UCD
•Rigorous UCD processes in place
•Efficient testing methods
•Extensive infrastructure
Well Developed UCD
Challenges: • Context and exposure • General process • Support
Challenges: • Resources • Participant access • Use case development
Challenges: • Detailed work flow analysis • Safety data
Ratwani RM, Fairbanks RJ, Hettinger AZ, Benda N. Electronic Health Record Usability: Analysis of the User Centered Design Processes of Eleven Electronic Health Record Vendors. Journal of the American Medical Informatics Association. 2015
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MedStar/AMA Usability Framework
• Many use cases lack rigor
• Metrics are inconsistent
• Risks identified through testing are rarely described
www.healthITusability.org Ratwani, R. M., Hettinger, A. Z., Kosydar, A., Fairbanks, R. J., & Hodgkins, M. L. (2016). A framework for evaluating electronic health record vendor user-centered design and usability testing processes. Journal of the American Medical Informatics Association, ocw092.
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What Will It Take? Collaboration
• Vendors: Cerner, Allscripts, athena, EHRA, etc
• Associations: AMA, ACP
• Advocacy: Pew
• Providers: CHOP, University of Florida, Christiana, Baylor Scott & White, UNC,
• Government Agencies: AHRQ, ONC, FDA, NIST
• Universities: Virginia Tech, Univ. at Buffalo, Georgetown, George Mason
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Acknowledgments Raj Ratwani, PhD Zach Hettinger, MD MS Natalie Benda, MS Scientific Director Medical Director Research Fellow Cognitive Psychologist Informaticist & Physician Human Factors Engineer
Our Health IT work has been supported by: NIH (NIBIB), AHRQ ,ONC, DoD, AMA, RTI, Pew, Emergency Medicine Patient Safety Foundation, and Latham Foundation.
[email protected] Twitter: @TerryFairbanks