UCD starts with understanding the users, so…10 minutes for this discussion
10 minutes for this
Some general concepts for you
Mini upa ehr discussion v4
Usability of Electronic Health Records: Interactive Discussion on How to Make Electronic Health Records Usable<br /> Kris EngdahlLauren ZackKaden RushfordTrisha FlanaganJannis Brea<br />
UX at athenahealth<br />Who is athenahealth?<br />We’re a cloud-based solution for practice management, electronic health records, and patient communications, serving physician practices<br />Our deep service offerings are based on proprietary web-native software, a continuously updated payer knowledge-base and integrated back-office service operations.<br />User Experience introduced to athenahealth in 2008<br />Backed by CEO, embedded in R&D processes, tackling really interesting UX problems<br />Has grown to a team of 14, providing: <br />User experience design<br />User research<br />Product copy<br />The company and the team are still growing (Come talk to us!)<br />
Why is EHR Usability such a hot topic?<br />Healthcare is a large industry <br />$2.5 trillion, 14.3 million jobs, 17.3% of GDP<br />It affects all of us<br />We are all once and future patients<br />We pay for everyone’s healthcare, either through insurance or taxes<br />Recent healthcare reform legislation encourages the adoption of EHRs<br />HITECH act includes incentives for “meaningful use” of EHRs<br />Government is discovering the field of usability as it evaluates EHRs<br />Healthcare providers are demanding better EHR usability<br />“It doesn’t look like it’s built for me” (system model != user mental model)<br />Better ease of learning<br />Better efficiency of use<br />Poor EHR usability can put patients at risk<br />
Discussion:How do we define EHR Usability?<br />What is an electronic health record (EHR)?<br />Electronic version of paper charting, plus capacity for electronic data exchange; managed by healthcare professionals<br />Used by single-physician practices, large healthcare networks, and everything in between<br />Different from a personal health record, which is managed by the patient<br />What is usability? (Choose your definition – here is the NIST definition)<br />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.”<br />Discussion: How do we define “usability” specifically re: EHRs?<br />What does it mean for an EHR to be usable?<br />Where does patient safety fit?<br />
How do we apply User Centered Design to the development of EHRs?<br />Essentially, just like any other UCD Process:<br />Start with users<br />Iteratively design and test<br />Collect data after deployment<br />And yet…there is something different about this arena<br />Let’s discuss this, piece by piece<br />
Discussion: Starting with users<br />Who are the users of EHRs?<br />Characteristics<br />Knowledge<br />Context<br />Goals<br />Tasks<br />What dimensions apply to the user population?<br />How do we scope / carry out user research? <br />
Discussion: Iterative design and testing<br />Who do we test with?<br />Who are “representative” users? <br />How do we get unbiased access to them?<br />What do we test?<br />Most EHRs are highly customized for individual practices. <br />How useful is a test of a “generic” version under development?<br />What tasks do we test?<br />What data do we use for testing?<br />Participants are always distracted by unrealistic data – so it has to be realistic<br />Real data is protected by HIPAA<br />
Discussion: Collecting data post-deployment<br />What kinds of summative evaluation are appropriate? <br />Can you compare usability of different EHRs?<br />How? <br />Summative testing?<br />With whom?<br />Using what?<br />What tasks?<br />What contexts?<br />Surveys? <br />Expert reviews?<br />Expert in what?<br />Same questions as with testing – tasks, contexts?<br />
References<br />General info on healthcare industry:<br />http://www.bls.gov/oco/cg/cgs035.htm<br />http://www.bnet.com/blog/healthcare-business/health-spending-hits-173-percent-of-gdp-in-largest-annual-jump/1117<br />What’s an EHR?<br />http://www.ama-assn.org/ama/pub/physician-resources/health-information-technology/health-it-basics/emrs-ehrs.page<br />Government documents on EHR usability<br />http://www.cchit.org/sites/all/files/CCHIT%20Usability%20Testing%20Guide%20Ambulatory%20EHRs%202011%20v6.pdf<br />http://www.nist.gov/itl/hit/upload/Guide_Final_Publication_Version.pdf<br />http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_907505_0_0_18/09(10)-0091-2-EF.pdf<br />http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_907504_0_0_18/09(10)-0091-1-EF.pdf<br />Information on EHR usability and patient safety<br />http://www.bmj.com/content/330/7491/581.full<br />http://www.useit.com/alertbox/20050411.html<br />http://www.jointcommission.org/sentinel_event_alert_issue_42_safely_implementing_health_information_and_converging_technologies/<br />
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