Your SlideShare is downloading. ×
0
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
ARRA & EMR Usability: What Providers Need to Know
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

ARRA & EMR Usability: What Providers Need to Know

2,678

Published on

What if US healthcare providers dramatically adopted EMRs in increasing numbers, worked hard to achieve meaningful use, but never benefited financially or in efficiency or quality? …

What if US healthcare providers dramatically adopted EMRs in increasing numbers, worked hard to achieve meaningful use, but never benefited financially or in efficiency or quality?

Meaningful use will be dependent on adequate EMR usability. Discover how usability relates to a number of meaningful use criteria. We offer a usability checklist to assist providers in shopping for a new EMR, or to use during implementation of an existing EMR, in order to achieve efficiency, effectiveness, and usefulness.

Presentation to HIMSS 2010 with co-presenter Janey Barnes PhD.

1 Comment
5 Likes
Statistics
Notes
No Downloads
Views
Total Views
2,678
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
167
Comments
1
Likes
5
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. ARRA and EMR Usability What Providers Need to Know
  • 2. Conflict of Interest Disclosure Jeff Belden MD Dr. 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.
  • 3. Conflict of Interest Disclosure Janey Barnes PhD Contracted Research: • Allscripts, • Patagonia Health, • Duke Health Systems
  • 4. Low EMR Adoption Rates
  • 5. EMR Adoption Hospitals - 2008 100% Full Basi Basic without None c clinician notes AK Jha et al, NEJM 2009
  • 6. EMR Adoption Doctor Offices – 2007-08 100% Full Basic None CM DesRoches et al, NEJM 2008
  • 7. Why?
  • 8. Barriers • Purchase price • Uncertain ROI • Lost productivity • Finding an EMR that meets needs • Obsolescence concerns
  • 9. Usability missing Smelcer 2009
  • 10. What is ^usability?
  • 11. Usability is Effectiveness Efficiency Satisfaction ISO 2003
  • 12. Usability means Learnable Efficient Memorable Error-free Satisfying Useit.com
  • 13. Current EMRs lack good usability Smelcer 2009
  • 14. examples
  • 15. Time consuming dictation takes 33 seconds EMR can take 10x longer
  • 16. Alert Fatigue of high-priority DDI alerts… 90% ignored
  • 17. Complex steps hard to learn Longer, costly training
  • 18. AAFP EMR Survey 2009 User satisfaction ratings from 2,012 Family Physicians
  • 19. Usability is…
  • 20. 10 Principles 1. Simplicity 7. Feedback 2. Naturalness 8. Effective use of 3. Consistency language 4. Minimizing cognitive 9. Effective information load presentation 5. Efficient interactions 10.Preservation of 6. Forgiveness context http://bit.ly/UsabilityHIMSS
  • 21. Simplicity
  • 22. Simplicity For doing refills For overview only
  • 23. Naturalness
  • 24. Naturalness Old way – lots of drill-down clicking
  • 25. Naturalness Better way we know the body already
  • 26. Consistency
  • 27. Consistency Name and identifying info consistently placed
  • 28. Minimizing Cognitive Load
  • 29. Minimizing Cognitive Load Exact past dates • This requires mental math
  • 30. Minimizing Cognitive Load Relative past dates • Easier. No extra thinking.
  • 31. Minimizing Cognitive Load Hover to see more detail • Have it both ways
  • 32. Efficient Interactions
  • 33. Efficient Interactions Dashboard efficiency
  • 34. Efficient Interactions 50 Clicks… • 6 minutes
  • 35. Efficient Interactions 2 Clicks… • 1-2 minutes
  • 36. Efficient Interactions Dashboard benefits • Single visual plane • No navigation away needed • No need to recall last screen’s content • Use hover-over, or pop-up windoids
  • 37. Efficient Interactions Dashboard principle Show me WINWINIANM (what I need, when I need it, and nothing more)
  • 38. Forgiveness
  • 39. Forgiveness Let users discover by exploring without fear of destroying Let users recover gracefully from mistakes
  • 40. Forgiveness A bad example…
  • 41. Feedback
  • 42. Feedback • Don’t keep the user wondering • Show expected delays • Confirm changes that aren’t evident
  • 43. Feedback Imagine this scenario • Imagine a user clicks a page element, and a long, slow database call ensues…
  • 44. Acceptable
  • 45. Better Please wait while we check 10,357 records…
  • 46. Best Time remaining… 8 seconds Please wait while we check 10,357 records…
  • 47. Effective Use of Language
  • 48. Terse for doctor Plain English for patient
  • 49. Effective Information Presentation
  • 50. Effective Information Presentation Sorted alphabetically, not randomly Better yet, allow sort by other criteria, t
  • 51. Preservation of Context
  • 52. Preservation of Context
  • 53. ARRA’s Meaningful Use Matrix Where does usability fit in?
  • 54. Meaningful Use (MU) 5 Health Outcome Policy Priorities 1. Improve quality, safety, efficiency, & reduce health disparities 2. Engage patients & families 3. Improve care coordination 4. Improve population & public health 5. Ensure adequate privacy & security protections for personal health information
  • 55. Meaningful Use (MU) We picked 3 1. Improve quality, safety, efficiency, & reduce health disparities 2. Engage patients & families 3. Improve care coordination 4. Improve population & public health 5. Ensure privacy & security protections for personal health information
  • 56. MU > Improve Quality 1. Improve Quality… 1. Evidence-based CPOE 2. Clinical decision support at the Point-of- care 3. Registries for patient outreach
  • 57. MU > Quality > EBM CPOE Evidence-based CPOE …building ruts to quality & safety examples…
  • 58. MU > Quality > EBM CPOE Antibiotic Selection for Community-Acquired Pneumonia Usability principles 1. Simplicity 2. Efficient interactions 3. Minimizing cognitive load
  • 59. MU > Quality > EBM CPOE
  • 60. MU > Quality > EBM CPOE > Simplicity Simplicity
  • 61. MU > Quality > EBM CPOE > Min cognitive load Minimize cognitive load
  • 62. MU > Quality > EBM CPOE > Efficient Efficient interactions
  • 63. MU > Quality > CDS at POC Clinical Decision Support at the Point of Care examples…
  • 64. MU > Quality > CDS at POC > Problem List Problem Lists Usability principles 1. Simplicity 2. Naturalness 3. Effective use of language 4. Effective information presentation
  • 65. MU > Quality > CDS at POC > Problem List > Simplicity Simplicity
  • 66. MU > Quality > CDS at POC > Problem List > Simplicity The old way...
  • 67. MU > Quality > CDS at POC > Problem List > Simplicity Better way
  • 68. MU > Quality > CDS at POC > Problem List > Naturalness Naturalness Sort & sequence like clinicians think Not by diagnosis code.. … but alphabetically
  • 69. MU > Quality > CDS at POC > Problem List > Naturalness Effective use of language Common ways you could display Diabetes 250.00 (ICD-9) Just use words physicians use What would Dr. Jesus say?
  • 70. MU > Quality > CDS at POC > Problem List > Info Prez Effective Info Presentation Sorted alphabetically Sorted for cardiology
  • 71. MU > Quality > CDS at POC > Problem List > Info Prez Effective Info Presentation Highlighted for cardiology Filtered for cardiology
  • 72. MU > Quality > CDS at POC > Alerts Alerts Usability principles 1. Simplicity 2. Efficiency 3. Effective information presentation
  • 73. MU > Quality > CDS at POC > Alerts > Simplicity Too busy visually…
  • 74. MU > Quality > CDS at POC > Alerts > Simplicity Try to find the essence…
  • 75. MU > Quality > CDS at POC > Alerts > Simplicity All the doctor needs to see
  • 76. MU > Quality > CDS at POC > Alerts > Simplicity Simplicity
  • 77. MU > Quality > CDS at POC > Alerts > Info Presentation Effective info presentation Show only what the physician wants • Severity • What is the adverse effect? • Alternative actions
  • 78. MU > Quality > CDS at POC > Alerts > Feedback Efficient interactions • Prevent repeated alerts for same combo • Prevent alerts for low-level danger • Let user adjust alert level
  • 79. MU > Quality > CDS at POC > Lab Lab results Usability principles 1. Effective information presentation 2. Minimize cognitive load 3. Preservation of context
  • 80. MU > Quality > CDS at POC > Lab > Info Presentation Effective info presentation old new
  • 81. MU > Quality > CDS at POC > Lab > Min cognitive load Minimize cognitive load
  • 82. MU > Quality > CDS at POC > Lab > Preserve context Preservation of context Compare to prior lab, two year graphical trend
  • 83. MU > Quality > CDS at POC > Lab > Preserve context And what medication is he/she on? And what is the weight and BP doing?
  • 84. MU > Quality > Registries Registries examples…
  • 85. MU > Quality > CDS at POC > Problem List Quality Registry: Dashboard Usability principles 1. Efficient interactions 2. Effective information presentation
  • 86. MU > Quality > Registries > Quality dashboard Diabetes quality dashboard
  • 87. MU > Quality > Registries > Quality dashboard Efficient interactions Give actionable info at Point-of-Care
  • 88. MU > Engaging Patients > Access to health record Engaging Patients Giving e-access to health records examples…
  • 89. MU > Engage patients Clinical Summary Usability principles 1. Effective use of language 2. Efficient interactions
  • 90. MU > Engage patients > Clinical summary Clinical Summary at Visit A take-home for the patient
  • 91. MU > Engage patients > Clinical summary
  • 92. MU > Engage patients > Clinical summary Effective Language Plain English
  • 93. MU > Engage patients > Clinical summary Efficient And something for the wallet
  • 94. MU > Engage patients > View lab on web Viewing lab results on web Usability principles 1. Effective use of language 2. Effective information presentation
  • 95. MU > Engage patients > View lab on web Viewing lab results on web
  • 96. MU > Engage patients > View lab on web Effective Language Change ”Reference” to ”Normal Range”
  • 97. MU > Engage patients > View lab on web Effective info presentation What would patient expect to find? •Highlight unviewed results •Abnormal in color •Doctor’s annotations to explain
  • 98. MU > Engage patients > View lab on web Effective Info Presentation Easy to misunderstand “which normal range”
  • 99. MU > Engage patients > e-Copy Web Access or e-Copy Usability principles 1. Naturalness 2. Forgiveness
  • 100. MU > Engage patients > e-Copy Naturalness
  • 101. MU > Engage patients > e-Copy Forgiveness
  • 102. EMR Buyer’s Guide Shopping for usability Before you buy, or implement…
  • 103. MU > Before you buy It’s a process… Define what’s Important to You • Evaluate your alternatives • Select the alternative that is best for your team
  • 104. MU > Before you buy What’s important to you Effectiveness •What do you want /need from your EMR? •How will this product meet those wants / needs? •See barriers when you try the product?
  • 105. MU > Before you buy What’s important to you Efficiency •What outcomes should be better • Faster • more robust • have better payoff
  • 106. MU > Before you buy What’s important to you Satisfaction •Of which users? •For which key tasks? •In which clinical setting or environment?
  • 107. MU > Before you buy Evaluate Your Alternatives What do your friends say • Ask, ask, ask! • Go watch your friends at work on their EMR • with their actual patients. • not a demo in the office. • watch others while you are there.
  • 108. MU > Before you buy Evaluate Your Alternatives What do your colleagues say • Blogs, etc. What do your professional groups & others say • KLAS • AAFP • Your state’s academy of …
  • 109. MU > Before you buy Evaluate Your Alternatives What do you and your team say • Do your own evaluation • Create 3-5 primary care clinical scenarios • Time critical tasks in those scenarios • Set targets that you want • A few users rate qualitative aspects of the software with 5-point scale • Evaluate reporting functions
  • 110. MU > Before you buy Creating Clinical Scenarios 1.Choose ones that matter • frequent, important • Include prescribing • Include “hey-doc” request 2.Test them 3.Look for efficiencies • e.g. document normal ROS with one click
  • 111. MU > Before you buy Buyer Beware Try Out the Reporting Function • What will you want to report? • A1Cs in diabetics • BP control rates in hypertension • List of patients on a particular recalled drug • Should be easy • Look for efficiencies • Out of the box experience • Easy to make reports quickly
  • 112. MU > Before you buy Buyer Beware Don’t be “wowed” by Templates Don’t be impressed with installed templates • Try them out first • Try to make one yourself (with no training) Don’t expect clinicians to create or edit • Try to make some • Ideal: Easy to make on the fly. • Even a caveman (a physician) can do it!
  • 113. MU > Before you buy Buyer Beware Training • Touch on initial training • you & staff will be overwhelmed at launch • Demand later training • after you have the basics down
  • 114. Want to learn more? • EMR Usability Principles and Proposed Testing • http://bit.ly/UsabilityHIMSS • Checklist - Evaluating Usability in an EMR before you buy • http://bit.ly/shopEMR
  • 115. ARRA & Usability: What Providers Need to Know Questions? Janey Barnes PhD | jbarnes@user-view.com Jeff Belden MD | beldenj@health.missouri.edu
  • 116. Want to learn more? • EMR Usability Principles and Proposed Testing • http://bit.ly/UsabilityHIMSS • Checklist - Evaluating Usability in an EMR before you buy • http://bit.ly/shopEMR Janey Barnes PhD | jbarnes@user-view.com Jeff Belden MD | beldenj@health.missouri.edu

×