Podcast: Unsalted Episode 6EHR: Secrets of Successful Usability

Prepared for: Macadamian Technologies

No. of pages: 9

Audio recording Identification: UnSalted_ep6 00:15:05

Transcript prepared by : Capital Transcription Services

Host: Graham Machacek, Manager of Marketing Communications, Macadamian Technologies

Guests: Nancy Staggers, Professor of Informatics, School of Nursing, University of Maryland

Lorraine Chapman, Director of Research, Macadamian Technologies

3/18/2013

Podcast: Unsalted Episode 6

++Audio++ 00:00:01

[Intro music]

Welcome to Macadamian’s audio Podcast- unsalted. Strategic insights on software development and

user experience design. We are bringing you snack-sized discussions your brain can munch on. Join the

conversation at macadamian.com.

Graham Machacek: Hi everyone, I am your host Graham Machacek, Manager of Marketing

Communications at Macadamian. In this exclusive podcast, we are focussing on

electronic healthcare records, secrets of successful usability. Before we get

started here is some context. A survey by Vitera Healthcare showed nine out of

ten physicians would like to be able to use EHRs on their mobile devices. The

most popular devices among the respondents were iPhone, iPad and Android

phones, but now while not specific to mobile, it is also worth noting the

Pennsylvania Patient Safety Authority found ten percent of EHR-related errors

led to quote on quote, “Unsafe conditions for patients”. On the healthcare IT

news website, I found a quote from Bill Marella, Program Director for the

Authority. He said this and I quote, “When most people talk about safety of

health IT they are thinking of software bugs, hardware failures or network

problems, but our data show issues are much more about human-computer

interface or the ways heath care providers interact with technology”. This leads

me to today’s discussion and so joining me is Lorraine Chapman, Director of

Research at Macadamian. Lorraine, how are you doing?

Lorraine Chapman: I am doing well thank you!

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Graham Machacek: Excellent. Also we are joined by Nancy Staggers, Professor of Informatics in the

School of Nursing at the University of Maryland. Nancy, how are you doing

today?

Nancy Staggers: I am excellent as well, thank you.

Graham Machacek: Well, thanks for joining. Recently, Nancy and Lorraine presented at the

Healthcare Information and Management System Society Conference in New

Orleans--of course, the HIMSS Conference. If you are listening you are probably

well aware of that. In this talk, they debunked top usability myths within the

context of EHRs, so I thought that would be a good place to start. Nancy, what

are some of the take home points from your presentation at HIMSS 2013?

Nancy Staggers: I thought I would like to highlight two major points from our presentation

Graham. Currently mobile devices are sweeping the imaginations and work flow

of clinicians and electronic health records users everywhere; it just seems like it

is on the tip of their tongue. At HIMSS, in particular, one of the task forces is

organized around the use and usability of mobile devices, so you might think

that mobile devices are good for everything and it is the answer to all of our

usability issues especially for EHRs, but really is more complex than that; one

device does not fit all of our needs. The key with usability is to match the device

to the particular task at hand and the context—that is the environment. For

example, a mobile device works really well as a physician is making rounds and

they need to look up one single thing like a lab result or if a nurse’s aide or

technician is trying to capture intake and output across ta team of patients

before the next shift starts. When a registered nurse wants to look up a

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medication at the patient’s bed side to better explain its actions, the mobile

device is perfect. But, if you think about the range of tasks that nurses and

physicians need to do, this same device would not work as well for say writing

clinical notes because the screen is too small for this task or if you are looking

up an entire electronic medication administration record, you need the larger

view to be able to look, for example, for the next medication that is due. Mobile

devices are better for single-user tasks like looking up lab results or looking up

one specific medication, but we in healthcare often work in teams. Supporting

teams is a whole different task and context and mobile devices may not work as

well for that. Another example might be looking up trends in physiologic

monitoring values for patients in ICU and you want to scan across a sea of data

to be able to pick out the ones that are abnormal or to see a trend, so a mobile

device maybe not as good for that particular task—that is one point. The second

major point is a misconception about the concept of usability itself. Some say

that usability is in the eye of the beholder-- that it is more art than science.

Usability is subjective and everyone sees usability different, that is, it cannot be

measures. Actually, forty years of research is available on concepts dealing with

usability or a more modern term is ‘the user experience’. Tools are actually

available to measure the concept. We know a lot about what constitutes

usability. There are models and framework, so those principles are known.

Graham Machacek: Okay, great. Lorraine, is there anything you want to expand on? You were there

too right?

[Laughter]

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Lorraine Chapman: Sure, absolutely!

Graham Machacek: Alright.

Lorraine Chapman: I guess on word—workflow. Nancy already touched on this especially in the

context of understanding when it is appropriate to use a mobile device versus a

desktop device. The key is really to think about and design to workflows with

context, people and process in mind. Workflows are not happening in isolation

and clinicians are not just using the EHR to accomplish a specific task. Usability

testing is definitely key to ensuring that workflows makes sense and clinicians

can work with EHR in an efficient and effective manner, but keep in mind

usability is not just about making it easy. Rather than just focussing on

simplifying the design or workflow, we as user experience experts should be

thinking about figuring what level of complexity the clinician can handle at

specific points in the workflow and for specific tasks.

Graham Machacek: Okay. Lorraine, we discussed the importance of allowing clinicians to interface

with different kinds of devices. Do you want to explain a little bit about that?

Lorraine Chapman: Yes, definitely. In context of design and users, we need to allow them to

interface with different devices in the easiest and most efficient way possible.

That can have great implications for clinicians and for e-patients. The more we

can understand about which points in a workflow a clinician needs access to a

device or application, the better able we are to design to that. However,

vendors have to also agree to make it easier to integrate with a variety of

different devices to make this work and that is just not happening today or at

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least it is very difficult today. HIT departments within hospitals are really having

big issues trying to deal with this. A great example is a staff nurse is taking a

temperature or other vitals with one device at the patient bed side and that

should be able to feed directly to the patient chart in the HR—that should just

happen seamlessly, but the systems in place often do not allow for that. What

about being about to pull up a patient education on an iPad, go over it with the

patient at the bed side, update it according to their specific needs especially

with regard to medication, so things like needing to take this two hours after

eating—being able to write that in with the patient at that particular time and

then emailing it to the patient’s home email address. That sounds simple right,

but, again, you would be surprised how broken this process currently is.

Graham Machacek: Okay and I also think we should touch on privacy. Nancy, obviously that is a big

topic and always will be especially when it comes to electronic healthcare

records. Are there any essential usability items you would want to highlight that

can improve privacy when it comes to EHRs?

Nancy Staggers: Okay, thanks for that question. Privacy, as you know, is a really hot topic in

North America as well as the rest of the international scene. In the US, in

particular, there has been a fair amount of recent press on recent security

breaches in EHR information, social security numbers-- those kinds of sensitive

data, so it seems like everybody is interested in enhancing privacy from the

individual clinician to leaders of organizations. Of course, the security folks say

they could just go to the extreme to protect privacy and just completely lock

down the system, but, of course, that does not make sense in the real world.

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Obviously, electronic health record users need access to information. They need

it at the right time, for the right patient and accessing the right data. Essentially,

privacy and data access are balancing acts; we are still trying to find the right

balance in that. For example, since we were talking earlier about mobile

devices, those mobile devices can make EHR access easier, but it could also

result in privacy or security breaches if, for instance, a clinician loses their device

and they do not have a password on it. Many organizations right now are

putting into place policies especially for mobile devices, for example, in the

American military, they do not allow extra devices like thumb drives for

instance. Other organizations allow them, but just basic security pre-sets have

to be in place like using a password for your thumb-drive, encrypting sensitive

information. If you are going to communicate with a patient and you are a

clinician using your mobile device, if you are sending sensitive information you

just go through data encryption to write emails with sensitive data.

Graham Machacek: Yes, I think even a member in my family has had data compromised even at a

local clinic.

Nancy Staggers: Yes.

Graham Machacek: Because somebody had our information on a thumb drive and it is scary.

Nancy Staggers: Yes, it is definitely a concern.

Graham Machacek: I think in terms of just data, the next topic to touch on is big data, right because

that is another big theme that everyone is talking about nowadays. Lorraine, I

thought it might be good if maybe we could touch on what our listeners need to

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know about this topic in the context of usability for electronic healthcare

records?

Lorraine Chapman: I certainly am not an expert in big data, but this is definitely an emerging tool in

healthcare and, obviously, it has great potential. For example, information

[weak] healthcare recently reported on this topic and highlighted a recent

report in the Journal of the American Medical Informatics Association and they

outlined and I quote, “An explorers project that looked at EHR-generated patient

data from nearly one million patients from several different healthcare systems.

The analysis helped clinicians pinpoint those most at risk for blood clots in the

extremities and lungs”. This is great, but not everyone is in a position to process

big data in a way that I just described; they simply just do not have access to it.

What can hospitals and clinics do? I think that EHRs can provide meaningful

information in the form of data analysis and visualization to clinicians and

administrators based on the data that they are currently documenting in the

system. Clinicians, for example, are interested in data analysis within a patient

chart and across patients within that clinic or unit. For example, if a patient has

diabetes, what does his disease pattern look like over a decade, for instance,

and better yet, visualize that data in such a way that a clinician can easily

consume it—and by consume it I mean instantly see trends or patterns that they

need to act on or at least make their patient aware of. Of course, administrators

are going to have different needs and goals with regard to data. They may want

to mine the data to understand where they can realize reduction and

expenditures, efficiencies and resources, or simply just look for trends and

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patterns in performance metrics across disciplines, units and hospital sites

because many hospitals are not just single sites anymore, they are multiple sites

within a city or across a certain portion of the country. Again, the key is to

present the information in a way that an administrator can act on it, so this is

really critical. Big data is useless unless we are giving people meaningful

information.

Graham Machacek: Okay, good key point. Again, we are talking about the secrets of successful

usability in the context of EHRs. Nancy, why not tell our listeners more about

the EHR usability self-assessment tool that you created.

Nancy Staggers: A team of folks on the usability task force of HIMSS, Healthcare Information and

Management Systems Society, created a usability maturity model. It is kind of a

fancy term, maturity model, that actually has a very practical bend and that is

that it helps organizations assess where they are in the stages of developing

usability over the user experience in their facilities. They begin with a stage

called ‘unrecognize’ and move to using usability at a strategic level. We give

rationale and past research about why usability is important and cost effective

in health organizations including vendor organizations. Then, we develop a

model that our listeners to this presentation can use to create improved levels

of usability. Particular dimensions are across five different areas—a focus on

users that increases as one goes up levels in maturity, management, a focus on

resources including funding, infrastructure to affect usability and then education

about the concept.

Graham Machacek: Okay, where can listeners access this tool?

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Nancy Staggers: It is actually a free publication; I am so glad that you asked. The easiest way to

do this is to just search for HIMSS in their browser and when you get the main

HIMSS page, then just type in the key word ‘usability and maturity’ and it will

pop right up for them.

Graham Machacek: Okay, that is great. Nancy, where can listeners reach you if they have more

questions about all of this?

Nancy Staggers: Okay, an easy address-- just staggers@son.umaryland.edu. SON stands for

School of Nursing.

Graham Machacek: Okay, great. Lorraine, same for you.

Lorraine Chapman: Everyone can reach me at lorraine@macadamian.com.

Graham Machacek: Okay. Of course you can always call Macadamian on our toll free line at 1-877-

779-6336 and we would be happy to discuss how we can collaborate to help you

achieve your business goals. We hope you have enjoyed this podcast and thank

everyone for listening—have a great week!

[Closing music]

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