EMR Usability - HIMSS Virtual Conf 09

Has no real or apparent conflicts of interest to report. Conflict of Interest Disclosure Jeff Belden MD

Understanding the Landscape of EMR Usability Implications for ARRA and Beyond

Jeff Belden MD
Associate Professor of Clinical Family Medicine
University of Missouri - Columbia
Chair – HIMSS Task Force on EMR Usability

Objectives
Define usability
List up to 10 principles of EMR usability
List usability requirements for “meaningful use”
Use a checklist when looking for usability in an EMR

What is usability?

Usability
It’s not just “user satisfaction”

Usability is
Effectiveness
Efficiency
Satisfaction
Specific users
Specific set of tasks
Particular environment

5 E s of Usability
Effective
Efficient
Engaging
Error tolerant
Easy to learn

Can usability be measured?
Yes it can

Counterpoint
“ User friendly? There is simply no way you can certify such – end of story.”
Chilmark
chilmarkresearch.com

10 Principles of Usability
Simplicity
Naturalness
Consistency
Minimizing cognitive load
Efficient interactions
Forgiveness
Feedback
Effective use of language
Effective information presentation
Preservation of context

Simplicity

Simplicity
For doing refills
For overview only

Simplicity
User: Surgeon
Task: Rounding

Minimize Cognitive Load Don’t make me think

Exact past dates
This requires mental math

Relative past dates
Easier. No extra thinking.

Hover to see more detail
Have it both ways

Efficiency The most measurable

Efficiency – How Fast?
Time to finish tasks
Click count
Other measures using Morae

Dashboard efficiency

50 Clicks…
6 minutes

… 2 Clicks
1-2 minutes

Dashboard benefits
Single visual plane
No navigation away needed
No need to recall last screen’s content
Use hover-over, or pop-up windoids

Hover Tool-tip

Windoid pop-up

Dashboard principle
Show me WINWINIANM
(what I need, when I need it, and nothing more)

Forgiveness Error tolerance

Forgiveness
Let users recover gracefully from mistakes

Feedback

Feedback
Don’t keep the user wondering
Show expected delays
Confirm changes that aren’t evident

Feedback
Imagine a user clicks a page element, and a long, slow database call ensues…

Acceptable

Better
Please wait while we check 10,357 records…

Best
Please wait while we check 10,357 records…
Time remaining… 8 seconds

Poor
Nothing changes visibly
What does the user think?
Should I click again?
Did the application lock up?

Effective Use of Language

Use of Language
Use the user’s natural language
Physician and nurse words both overlap and diverge
Managers speak non-clinical language

Use of Language
Be terse
First words are critical

First words matter
Wrong sequence
Culture, blood, peripheral
Culture, blood, central line
Culture, urine, catheter
Culture, urine, clean-voided
Better sequence
Blood , peripheral (culture)
Blood, central line (culture)
Urine, catheter (culture)
Urine, clean-voided (culture)

Effective Information Presentation

Information presentation Vertical text harder to read

Information presentation Horizontal text easier to read. Takes up same space.

Naturalness

Naturalness
Feels familiar
Like real world
Works like the web
Easy to learn

ARRA Usability Requirements for “meaningful use”

What ARRA has to say about usability
nothing

So why should you care?
90 % of doctors surveyed said they are either “concerned” or “very concerned” about usability as a leading obstacle to EHR adoption.
Nuance survey, June 2009
90 % concerned about usability

David Blumenthal MD MPP | ONCHIT
… many certified EHRs [not] user-friendly …
“ … many certified EHRs [not] user-friendly … “

[CCHIT will] pilot test a 'first step' basic usability assessment program …
“ [CCHIT will] pilot test a 'first step' basic usability assessment program … “

Shopping for EMR? Here are some tips

No online stores yet

Ratings
Available but restricted
KLAS (for users who rated their own)
AAFP (Family Physician members only)

Make a shopping list
Create clinical scenarios to test
Time critical tasks
Set targets (6 clicks for simple acute illness)
# of clicks, time to complete task
Have your group do qualitative ratings
Use some of our 10 principles
Test the EMRs reporting function

Creating clinical scenarios
Choose ones that matter
common, important
Include prescribing
Include “hey-doc” request
Test them
Look for efficiencies
(e.g. document normal ROS with one click?)

Try out 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
Out of the box, or
Easy to make quickly

Don’t be “wowed” by templates
Don’t be impressed with installed templates
Try them out first!
Don’t expect clinicians to create or edit
Try to make some
Ideal: easy to make on the fly

Still need help?
Use our online shopping checklist
http://bit.ly/shopEMR

Want to learn more?
Read more about principles & methods of testing
http://bit.ly/UsabilityHIMSS

Want to learn more?
How to do simple usability testing
http://bit.ly/lo4Wn

Thanks
HIMSS EMR Usability Task Force
Authors
Janey Barnes PhD
Rebecca Grayson
Jeff Belden MD
Team Leaders
Penn White MD
Tiana Thomas

Questions?

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EMR Usability - HIMSS Virtual Conf 09

by Jeff Belden MD on Nov 04, 2009

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EMR Usability - HIMSS Virtual Conf 09 — Presentation Transcript