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Usability of EHRs - Engdahl, Zack, Rushford, Flanagan, Brea


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UPA Boston discussion of EHR Usability

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Usability of EHRs - Engdahl, Zack, Rushford, Flanagan, Brea

  1. 1. Usability of Electronic Health Records: Interactive Discussion on How to Make Electronic Health Records Usable<br /> Kris EngdahlLauren ZackKaden RushfordTrisha FlanaganJannis Brea<br />
  2. 2. 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 />
  3. 3. 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 />
  4. 4. 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 />
  5. 5. 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 />
  6. 6. 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 />
  7. 7. 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 />
  8. 8. 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 />
  9. 9. References<br />General info on healthcare industry:<br /><br /><br />What’s an EHR?<br /><br />Government documents on EHR usability<br /><br /><br /><br /><br />Information on EHR usability and patient safety<br /><br /><br /><br />