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EMR Usability - HIMSS Virtual Conf 09
 

EMR Usability - HIMSS Virtual Conf 09

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Slides from my closing keynote presentation at HIMSS Virtual Conference, November 4, 2009.

Slides from my closing keynote presentation at HIMSS Virtual Conference, November 4, 2009.

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  • We had similar arguments in the early days of health care quality improvement movement. “You can’t measure quality in health care!” It’s too subjective, can’t be quantified, patients don’t know how to judge it. Those claims turned out to
  • Depends on knowing: User Tasks Environment
  • http://www.nuance.com/healthcare/ehr-meaningful-use-study/ In fact, 90 percent of doctors surveyed said they are either “concerned” or “very concerned” about usability as a leading obstacle to EHR adoption . Following usability, issues related to cost, learning curves of a new system, increased time documenting care, and inability to use dictation to create medical notes were also identified as obstacles that need to be addressed. [June 18. 2009 Nuance Survey]
  • ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT. http://chilmarkresearch.com/2009/03/27/blumenthals-views-lock-down-on-hit-innovation/
  • Personal communication, October 2009
  • Create Clinical Scenarios Choose ones that matter (common, important) Acute sinusitis, UTI, well woman exam (for primary care, for example) Test them Hire help or read “Don’t Make Me Think” by Steve Krug, on doing discount usability testing. Do the “out of the box” templates cover your most common needs? Is customization required? Or is customization optional (preferred)?
  • http://bit.ly/shopEMR
  • http://bit.ly/UsabilityHIMSS Defining and Testing EMR Usability:  Principles and Proposed Methods of EMR Usability Evaluation and Rating HIMSS EHR Usability Task Force  June 2009 
  • Peachpit.com Steve Krug Don’t Make Me Think http://bit.ly/lo4Wn

EMR Usability - HIMSS Virtual Conf 09 EMR Usability - HIMSS Virtual Conf 09 Presentation Transcript

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