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EMRs: Only Meaningful When They're Usable
 

EMRs: Only Meaningful When They're Usable

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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 ...

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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  • Setting up a usability test involves carefully creating a scenario , or realistic situation, wherein the person performs a list of tasks using the product being tested while observers watch and take notes. Several other test instruments such as scripted instructions, paper prototypes , and pre- and post-test questionnaires are also used to gather feedback on the product being tested. For example, to test the attachment function of an e-mail program, a scenario would describe a situation where a person needs to send an e-mail attachment, and ask him or her to undertake this task. The aim is to observe how people function in a realistic manner, so that developers can see problem areas, and what people like. Techniques popularly used to gather data during a usability test include think aloud protocol and eye tracking .
  • Setting up a usability test involves carefully creating a scenario , or realistic situation, wherein the person performs a list of tasks using the product being tested while observers watch and take notes. Several other test instruments such as scripted instructions, paper prototypes , and pre- and post-test questionnaires are also used to gather feedback on the product being tested. For example, to test the attachment function of an e-mail program, a scenario would describe a situation where a person needs to send an e-mail attachment, and ask him or her to undertake this task. The aim is to observe how people function in a realistic manner, so that developers can see problem areas, and what people like. Techniques popularly used to gather data during a usability test include think aloud protocol and eye tracking .
  • Also people’s opinion (perceptions) can be different from their performance. E.g., after struggling through a task (maybe failing to complete the task) participants will rate the task (verbally and/or with post task questionnaires) as easy to do or not so hard…even if they failed. Now the usability needs to prioritize performance data versus perception/opinion data.

EMRs: Only Meaningful When They're Usable EMRs: Only Meaningful When They're Usable Presentation Transcript

  • EMRs Only Meaningful When They’re Usable
  • 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.
  • Adoption
  • Adoption What’s the friction ?
  • Acquisition Costs
    • Lost productivity
    • Long training times
    • Rebellion
    Poor Usability Smelcer 2009
  • What is usability? EMR ^
  • Usability is
    • Effectiveness
    • Efficiency
    • Satisfaction
    ISO 2003
  • Usability means
    • Learnable
    • Efficient
    • Memorable
    • Error-free
    • Satisfying
    Useit.com
  • Usability is…
  • 10 Principles
    • Simplicity
    • Naturalness
    • Consistency
    • Minimizing cognitive load
    • Efficient interactions
    • Forgiveness
    http://bit.ly/UsabilityHIMSS
    • Feedback
    • Effective use of language
    • Effective information presentation
    • 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
    • Have it both ways
    Hover to see more detail
  • Efficient Interactions
  • Efficient Interactions Dashboard efficiency
  • Efficient Interactions
    • 6 minutes
    50 Clicks…
  • Efficient Interactions
    • 1-2 minutes
    2 Clicks…
  • 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 Users
    • Don’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 mining
    • Collect 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 vivo If the mountain won’t come to Mohammed, Mohammed must go to the mountain
  • Take the usability lab to the interruptive clinical environment
    • New technologies make this more possible
  • Webcams built-in WiFi
  • Morae software records user face, 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
  • Questions? EMRs: Only Meaningful When They’re Usable Jeff Belden MD | [email_address] www.toomanyclicks.com