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Boston Mini UPA EHR Discussion



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  • Welcome, thank you, introductions
  • Just a Who We Are slide
  • 5 minutes max
  • 5- 10 minutes for this discussion
  • This is just an intro slide
  • UCD starts with understanding the users, so…10 minutes for this discussion
  • 10 minutes for this
  • Some general concepts for you


  • 1. Usability of Electronic Health Records: Interactive Discussion on How to Make Electronic Health Records Usable
    Kris EngdahlLauren ZackKaden RushfordTrisha FlanaganJannis Brea
  • 2. UX at athenahealth
    Who is athenahealth?
    We’re a cloud-based solution for practice management, electronic health records, and patient communications, serving physician practices
    Our deep service offerings are based on proprietary web-native software, a continuously updated payer knowledge-base and integrated back-office service operations.
    User Experience introduced to athenahealth in 2008
    Backed by CEO, embedded in R&D processes, tackling really interesting UX problems
    Has grown to a team of 14, providing:
    User experience design
    User research
    Product copy
    The company and the team are still growing (Come talk to us!)
  • 3. Why is EHR Usability such a hot topic?
    Healthcare is a large industry
    $2.5 trillion, 14.3 million jobs, 17.3% of GDP
    It affects all of us
    We are all once and future patients
    We pay for everyone’s healthcare, either through insurance or taxes
    Recent healthcare reform legislation encourages the adoption of EHRs
    HITECH act includes incentives for “meaningful use” of EHRs
    Government is discovering the field of usability as it evaluates EHRs
    Healthcare providers are demanding better EHR usability
    “It doesn’t look like it’s built for me” (system model != user mental model)
    Better ease of learning
    Better efficiency of use
    Poor EHR usability can put patients at risk
  • 4. Discussion:How do we define EHR Usability?
    What is an electronic health record (EHR)?
    Electronic version of paper charting, plus capacity for electronic data exchange; managed by healthcare professionals
    Used by single-physician practices, large healthcare networks, and everything in between
    Different from a personal health record, which is managed by the patient
    What is usability? (Choose your definition – here is the NIST definition)
    ISO 9421-11: “The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use.”
    Discussion: How do we define “usability” specifically re: EHRs?
    What does it mean for an EHR to be usable?
    Where does patient safety fit?
  • 5. How do we apply User Centered Design to the development of EHRs?
    Essentially, just like any other UCD Process:
    Start with users
    Iteratively design and test
    Collect data after deployment
    And yet…there is something different about this arena
    Let’s discuss this, piece by piece
  • 6. Discussion: Starting with users
    Who are the users of EHRs?
    What dimensions apply to the user population?
    How do we scope / carry out user research?
  • 7. Discussion: Iterative design and testing
    Who do we test with?
    Who are “representative” users?
    How do we get unbiased access to them?
    What do we test?
    Most EHRs are highly customized for individual practices.
    How useful is a test of a “generic” version under development?
    What tasks do we test?
    What data do we use for testing?
    Participants are always distracted by unrealistic data – so it has to be realistic
    Real data is protected by HIPAA
  • 8. Discussion: Collecting data post-deployment
    What kinds of summative evaluation are appropriate?
    Can you compare usability of different EHRs?
    Summative testing?
    With whom?
    Using what?
    What tasks?
    What contexts?
    Expert reviews?
    Expert in what?
    Same questions as with testing – tasks, contexts?
  • 9. References
    General info on healthcare industry:
    What’s an EHR?
    Government documents on EHR usability
    Information on EHR usability and patient safety