emr usability - himss virtual conf 09
DESCRIPTION
Slides from my closing keynote presentation at HIMSS Virtual Conference, November 4, 2009.TRANSCRIPT
Has no real or apparent conflicts of interest to report.
Conflict of Interest Disclosure
Jeff Belden MD
Understanding the Landscape of
EMR Usability Implications for ARRA and Beyond
Jeff Belden MD
• Associate Professor of Clinical Family Medicine
• University of Missouri - Columbia
• Chair – HIMSS Task Force on EMR Usability
Objectives
1. Define usability2. List up to 10 principles of EMR usability3. List usability requirements for “meaningful
use”4. Use a checklist when looking for usability
in an EMR
What is usability?
Usability
• It’s not just “user satisfaction”
Usability is
• Effectiveness• Efficiency• Satisfaction
– Specific users– Specific set of tasks– Particular environment
Usability is
• Effectiveness• Efficiency• Satisfaction
– Specific users– Specific set of tasks– Particular environment
Usability is
• Effectiveness• Efficiency• Satisfaction
– Specific users– Specific set of tasks– Particular environment
Usability is
• Effectiveness• Efficiency• Satisfaction
– Specific users– Specific set of tasks– Particular environment
5 Es of Usability
• Effective• Efficient• Engaging• Error tolerant• Easy to learn
Can usability be measured?
Yes it can
Counterpoint
“User friendly? There is simply no way you can certify such – end of story.”
Chilmarkchilmarkresearch.com
10 Principles of Usability• Simplicity• Naturalness• Consistency• Minimizing cognitive
load• Efficient interactions• Forgiveness
• Feedback• Effective use of
language• Effective information
presentation• Preservation of
context
Simplicity
Simplicity
For doing refills
For overview only
Simplicity• User: Surgeon• Task: Rounding
Minimize Cognitive LoadDon’t make me think
Exact past dates• This requires mental math
Relative past dates• Easier. No extra thinking.
Hover to see more detail• Have it both ways
EfficiencyThe most measurable
Efficiency – How Fast?
• Time to finish tasks• Click count• Other measures using Morae
Dashboard efficiency
50 Clicks…• 6 minutes
…2 Clicks• 1-2 minutes
Dashboard benefits
• Single visual plane• No navigation away needed• No need to recall last screen’s content• Use hover-over, or pop-up windoids
Hover Tool-tip
Windoid pop-up
Dashboard principle
Show me WINWINIANM
(what I need, when I need it, and nothing more)
ForgivenessError tolerance
ForgivenessLet users recover gracefully from mistakes
Feedback
Feedback
• Don’t keep the user wondering• Show expected delays• Confirm changes that aren’t evident
Feedback
• Imagine a user clicks a page element, and a long, slow database call ensues…
Acceptable
Better
Please wait while we check 10,357 records…
Best
Please wait while we check 10,357 records…
Time remaining… 8 seconds
Poor
• Nothing changes visibly
• What does the user think?– Should I click again?– Did the application lock up?
Effective Use of Language
Use of Language
• Use the user’s natural language– Physician and nurse words both overlap and
diverge– Managers speak non-clinical language
Use of Language
• Be terse• First words are critical
First words matter
Wrong sequenceCulture, blood, peripheralCulture, blood, central lineCulture, urine, catheterCulture, urine, clean-voided
Better sequenceBlood , peripheral (culture)Blood, central line (culture)Urine, catheter (culture)Urine, clean-voided (culture)
Effective Information Presentation
Information presentationVertical text harder to read
Information presentationHorizontal text easier to read.
Takes up same space.
Naturalness
Naturalness
• Feels familiar– Like real world– Works like the web
• Easy to learn
ARRA Usability Requirements
for “meaningful use”
What ARRA has to say about usability
nothing
So why should you care?
90 % of doctors surveyed said they are either “concerned” or “very concerned” about usability as a leading obstacle to EHR adoption.
Nuance survey, June 2009
90 % concerned about usability
David Blumenthal MD MPP | ONCHIT
… many certified EHRs [not] user-friendly …“ … many certified
EHRs [not] user-friendly …“
[CCHIT will] pilot test a 'first step' basic usability assessment program…“
[CCHIT will] pilot test a 'first step' basic usability assessment program…“
Shopping for EMR?Here are some tips
No online stores yet
Ratings
• Available but restricted– KLAS (for users who rated their own)– AAFP (Family Physician members only)
Make a shopping list
1. Create clinical scenarios to test2. Time critical tasks
– Set targets (6 clicks for simple acute illness)– # of clicks, time to complete task
3. Have your group do qualitative ratings– Use some of our 10 principles
4. Test the EMRs reporting function
Creating clinical scenarios
1. Choose ones that matter1. common, important2. Include prescribing3. Include “hey-doc” request
2. Test them3. Look for efficiencies
– (e.g. document normal ROS with one click?)
Try out reporting function
• What will you want to report?– A1Cs in diabetics– BP control rates in hypertension– List of patients on a particular recalled drug
• Should be easy– Out of the box, or– Easy to make quickly
Don’t be “wowed” by templates
• Don’t be impressed with installed templates
– Try them out first!• Don’t expect clinicians to create or edit• Try to make some• Ideal: easy to make on the fly
Still need help?
• Use our online shopping checklist
• http://bit.ly/shopEMR
Want to learn more?
• Read more about principles & methods of testing
• http://bit.ly/UsabilityHIMSS
Want to learn more?
• How to do simple usability testing
• http://bit.ly/lo4Wn
Thanks• HIMSS EMR Usability Task Force• Authors
– Janey Barnes PhD– Rebecca Grayson– Jeff Belden MD
• Team Leaders– Penn White MD– Tiana Thomas
Questions?