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 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

    1. 1. EMRs Only Meaningful When They’re Usable
    2. 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. 3. Adoption
    4. 4. Adoption What’s the friction ?
    5. 5. Acquisition Costs <ul><li>Lost productivity </li></ul><ul><li>Long training times </li></ul><ul><li>Rebellion </li></ul>Poor Usability Smelcer 2009
    6. 6. What is usability? EMR ^
    7. 7. Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul>ISO 2003
    8. 8. Usability means <ul><li>Learnable </li></ul><ul><li>Efficient </li></ul><ul><li>Memorable </li></ul><ul><li>Error-free </li></ul><ul><li>Satisfying </li></ul>Useit.com
    9. 9. Usability is…
    10. 10. 10 Principles <ul><li>Simplicity </li></ul><ul><li>Naturalness </li></ul><ul><li>Consistency </li></ul><ul><li>Minimizing cognitive load </li></ul><ul><li>Efficient interactions </li></ul><ul><li>Forgiveness </li></ul>http://bit.ly/UsabilityHIMSS <ul><li>Feedback </li></ul><ul><li>Effective use of language </li></ul><ul><li>Effective information presentation </li></ul><ul><li>Preservation of context </li></ul>
    11. 11. Simplicity
    12. 12. For doing refills For overview only Simplicity
    13. 13. Naturalness
    14. 14. Naturalness Old way – lots of drill-down clicking
    15. 15. Naturalness Better way we know the body already
    16. 16. Consistency
    17. 17. Consistency Name and identifying info consistently placed
    18. 18. Minimizing Cognitive Load
    19. 19. Minimizing Cognitive Load Exact past dates <ul><li>This requires mental math </li></ul>
    20. 20. Minimizing Cognitive Load Relative past dates <ul><li>Easier. No extra thinking. </li></ul>
    21. 21. Minimizing Cognitive Load <ul><li>Have it both ways </li></ul>Hover to see more detail
    22. 22. Efficient Interactions
    23. 23. Efficient Interactions Dashboard efficiency
    24. 24. Efficient Interactions <ul><li>6 minutes </li></ul>50 Clicks…
    25. 25. Efficient Interactions <ul><li>1-2 minutes </li></ul>2 Clicks…
    26. 26. Forgiveness
    27. 27. Forgiveness Let users discover by exploring without fear of destroying Let users recover gracefully from mistakes
    28. 28. Forgiveness <ul><li>A bad example… </li></ul>
    29. 29. Feedback
    30. 30. Acceptable
    31. 31. Better <ul><li>Please wait while we check 10,357 records… </li></ul>
    32. 32. Best <ul><li>Please wait while we check 10,357 records… </li></ul>Time remaining… 8 seconds
    33. 33. Effective Use of Language
    34. 34. Plain English for patient Terse for doctor
    35. 35. Effective Information Presentation
    36. 36. Effective Information Presentation Sorted alphabetically, not randomly Better yet, allow sort by other criteria, too
    37. 37. Preservation of Context
    38. 38. Preservation of Context
    39. 39. Usability Methods
    40. 42. Prototyping
    41. 43. Prototyping <ul><li>Should look preliminary </li></ul><ul><li>Encourages user suggestions for change </li></ul>
    42. 44. Prototyping methods <ul><li>Paper </li></ul><ul><li>Simple wireframe </li></ul><ul><ul><li>PowerPoint </li></ul></ul><ul><ul><li>Keynote (Mac) </li></ul></ul><ul><ul><li>Interactive </li></ul></ul><ul><ul><ul><li>Visio (Win) or OmniGraffle (Mac) </li></ul></ul></ul>
    43. 45. Think-Aloud Testing
    44. 46. Think-Aloud Testing <ul><li>Let me record you as you test/use my software. </li></ul>
    45. 47. Think-Aloud Testing <ul><li>Learn more </li></ul><ul><li>Read this book </li></ul><ul><li>Download the instructions to do your own testing. </li></ul><ul><ul><li>http://bit.ly/Dthink </li></ul></ul>
    46. 48. Test Early & Often
    47. 49. Test Early & Often <ul><li>Test 5 users, fix, repeat </li></ul><ul><li>Reduces need to rework later </li></ul>
    48. 50. Watch Users <ul><li>Don’t believe what we say we do </li></ul><ul><ul><li>See what we do, instead. </li></ul></ul><ul><li>User’s perception may be different from performance </li></ul><ul><ul><li>“ I failed to complete that task?” </li></ul></ul><ul><li>Users may not know what we want until we see what’s possible </li></ul>
    49. 51. Finding Users <ul><li>Wander like Gandhi </li></ul><ul><li>Collect them keep a Rolodex </li></ul><ul><li>Go to their hangouts like Kinsey </li></ul>
    50. 52. Emerging Trends
    51. 53. CCHIT 5-star Ratings
    52. 54. CCHIT Usability Testing <ul><li>Gathering baseline data </li></ul><ul><li>9 products tested so far (Jan 2009) </li></ul><ul><li>Mean score = 4.4 </li></ul><ul><ul><li>Too generous? </li></ul></ul>
    53. 55. AHRQ Research & Policy Agenda
    54. 56. AHRQ Papers <ul><li>EHR Usability: Evaluation & Use Case Framework </li></ul><ul><ul><ul><li>http://bit.ly/AHRQux1 </li></ul></ul></ul><ul><li>EHR Usability: Interface Design Considerations </li></ul><ul><ul><ul><li>http://bit.ly/AHRQux2 </li></ul></ul></ul>
    55. 57. Data mining user behavior
    56. 58. Data mining <ul><li>Collect analytics data on EMR users </li></ul><ul><ul><li>Find patterns of difficult use </li></ul></ul><ul><ul><li>Find user errors </li></ul></ul><ul><ul><li>Do think-aloud test </li></ul></ul><ul><ul><li>Retool, retrain, or retrench </li></ul></ul>
    57. 59. Vendor-User Collaboration in vivo If the mountain won’t come to Mohammed, Mohammed must go to the mountain
    58. 60. Take the usability lab to the interruptive clinical environment <ul><li>New technologies make this more possible </li></ul>
    59. 61. Webcams built-in WiFi
    60. 62. Morae software records user face, voice, clicks, keystrokes, times
    61. 63. Small, cheap, good video cameras
    62. 64. Web capture from ASP model EMRs
    63. 65. Social networking
    64. 66. Want to learn more? <ul><li>EMR Usability Principles and Proposed Testing </li></ul><ul><ul><ul><li>http://bit.ly/UsabilityHIMSS </li></ul></ul></ul><ul><li>Checklist - Evaluating EMR Usability before you buy </li></ul><ul><ul><li>http://bit.ly/shopEMR </li></ul></ul><ul><li>HIMSS 2010 </li></ul><ul><ul><li>Session 57: </li></ul></ul><ul><ul><ul><li>ARRA and EMR Usability: What Providers Need to Know </li></ul></ul></ul><ul><ul><li>E-Session 409: </li></ul></ul><ul><ul><ul><li>EHR Usability: Pain Points Evaluation and Results </li></ul></ul></ul>
    65. 67. Questions? EMRs: Only Meaningful When They’re Usable Jeff Belden MD | [email_address] www.toomanyclicks.com

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