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Take a look at what makes an EMR usable. It’s more than user satisfaction. Learn how EMR Usability is getting more attention at the national level in certification, standards, research, and policy.Closing keynote presentation at HIMSS 2010 Academic Forum in Atlanta GA.
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EMRsOnly Meaningful When They’re Usable
Conflict of Interest Disclosure
Jeff Belden MDDr. Belden is on the faculty at University of
Missouri - Columbia, which has a contractual consulting relationship with Cerner for EMR research and development.
Dr. Belden has no financial interest.
Adoption
Adoption
What’s the friction?
Acquisition Costs
• Lost productivity• Long training times• Rebellion
Poor Usability
Smelcer 2009
What is usability?EMR
^
Usability isEffectivenessEfficiencySatisfaction
ISO 2003
Usability meansLearnableEfficientMemorableError-freeSatisfying
Useit.com
Usability is…
10 Principles1. Simplicity2. Naturalness3. Consistency4. Minimizing
cognitive load5. Efficient
interactions6. Forgiveness
http://bit.ly/UsabilityHIMSS
7. Feedback8. Effective use of
language9. Effective
information presentation
10.Preservation of context
Simplicity
For doing refills
For overview only
Simplicity
Naturalness
Naturalness
Old way – lots of drill-down clicking
Naturalness
Better way we know the body already
Consistency
Consistency
Name and identifying info consistently placed
Minimizing Cognitive Load
Minimizing Cognitive Load
Exact past dates• This requires mental math
Minimizing Cognitive Load
Relative past dates• Easier. No extra thinking.
Minimizing Cognitive Load
Hover to see more detail• Have it both ways
Efficient Interactions
Dashboard efficiencyEfficient Interactions
Efficient Interactions
50 Clicks…• 6 minutes
Efficient Interactions
2 Clicks…• 1-2 minutes
Forgiveness
Forgiveness
Let users discover by exploring without fear of destroying
Let users recover gracefully from mistakes
Forgiveness
A bad example…
Feedback
Acceptable
Better
Please wait while we check 10,357
records…
Best
Please wait while we check 10,357
records…
Time remaining… 8 seconds
Effective Use of Language
Plain English for patient
Terse for doctor
Effective Information Presentation
Effective Information Presentation
Sorted alphabetically, not randomly
Better yet, allow sort by other criteria, too
Preservation of Context
Preservation of Context
Usability Methods
Prototyping
Prototyping
• Should look preliminary• Encourages user suggestions for
change
Prototyping methods
• Paper• Simple wireframe• PowerPoint• Keynote (Mac)
• Interactive• Visio (Win) or OmniGraffle (Mac)
Think-Aloud Testing
Think-Aloud Testing• Let me record you as you
test/use my software.
Think-Aloud Testing
Learn more• Read this book• Download the
instructions to do your own testing.
http://bit.ly/Dthink
Test Early & Often
Test Early & Often• Test 5 users, fix, repeat• Reduces need to rework later
Watch UsersDon’t believe what we say we do• See what we do, instead.
User’s perception may be different from performance• “I failed to complete that task?”
Users may not know what we want until we see what’s possible
Finding Users• Wander like Gandhi
• Collect them keep a Rolodex
• Go to their hangouts like Kinsey
Emerging Trends
CCHIT 5-star Ratings
CCHIT Usability Testing• Gathering
baseline data• 9 products
tested so far (Jan 2009)
• Mean score = 4.4
– Too generous?
AHRQ Research & Policy Agenda
AHRQ Papers• EHR Usability: Evaluation &
Use Case Framework http://bit.ly/AHRQux1
• EHR Usability: Interface Design Considerations
http://bit.ly/AHRQux2
Data mining user behavior
Data miningCollect analytics data on EMR
users• Find patterns of difficult use• Find user errors• Do think-aloud test• Retool, retrain, or retrench
Vendor-User Collaboration
in vivoIf the mountain won’t come to
Mohammed, Mohammed must go to the mountain
Take the usability lab to the interruptive clinical
environmentNew technologies make this more
possible
Webcams built-in WiFi
Morae software records userface, voice, clicks, keystrokes, times
Small, cheap, good video cameras
Web capture from ASP model EMRs
Social networking
Want to learn more?• EMR Usability Principles and Proposed Testing
• http://bit.ly/UsabilityHIMSS
• Checklist - Evaluating EMR Usability before you buy• http://bit.ly/shopEMR
• HIMSS 2010• Session 57: • ARRA and EMR Usability: What Providers Need to
Know• E-Session 409: • EHR Usability: Pain Points Evaluation and Results
