When the Agency for Healthcare Research and Quality (AHRQ) released its report "Electronic Health Record Usability: Vendor Practices and Perspectives" this past spring, its first words of warning were that design and ease of use were major sticking points.
Although the vendors surveyed "described an array of usability engineering processes and the use of end users throughout the product life cycle," it read, "practices such as formal usability testing, the use of user-centered design processes, and specific resource personnel with expertise in usability engineering are not common."
Rigorous, thoughtful, and proactive design, the report made clear, was essential for making EMRs that are easier to use – thus leading to more widespread acceptance and better patient outcomes.
Central to that goal was encouraging "formal usability testing early in the design and development phase as a best practice, and [discouraging] dependence on post-deployment review supporting usability assessments," the report read. "By not identifying critical usability issues through a wide range of user testing during design and development, vendors are opening the door to potential patient safety incidents and costly post-release fixes."
At a session at June's HIMSS Virtual Conference and Expo, Jeffery Belden, MD, a physician with the department of family and community medicine at the University of Missouri, and Janey Barnes, the human factors specialist at User-View Inc., presented a detailed and user-focused design process for vendors developing EMRs.
"Don't forget the buyer's side of usability," were Belden's marching orders, as he led attendees through the stages of efficacious EMR design and development, from initial note-taking and information gathering, through brainstorming and storyboarding, to beta testing, launching and beyond.
Understanding the end-user's tasks is critical, said Belden, recommending that EMR makers make one or more on-site visits to observe physicians and clinicians at work. Make special note of the "workflow and environment of the users," Belden said, "specify how users carry out their tasks in a specific process."
Perhaps ironically for an industry that seeks nothing less than the wholesale replacement of paper-based health records, Belden said designers should make generous use of paper, and that "pencil works just fine."
Because sketches, note cards and sticky notes are perfect vehicles for brainstorming screen design, he said – easily grouped and regrouped and clustered and rearranged again.
"Paper is cheap and quick," said Belden. And card sorting "aids information design," allowing the EMR developers a spontaneous way to work through the finding of "latent structures in an unsorted group of ideas."
Having surveyed physicians and surmised their workplace wants and needs, Belden says designers should then rank those necessary and/or desirable features and functions, and then use the fungibility of notecards and a bulletin board to move various components around, helping them discover "users' mental model" and hopefully arriving at an optimal design.
Because in the end, added Barnes later, visual design is "not just about pretty colors." It's about "communicating information organization and priority."
For electronic health records, that means making technology that's easy and appealing for doctors, nurses and clinicians to use – and, in turn, translates into better outcomes for patients.
