EMRs: Only Meaningful When They're Usable
-
Upload
jeff-belden-md -
Category
Health & Medicine
-
view
2.167 -
download
1
description
Transcript of EMRs: Only Meaningful When They're Usable
![Page 1: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/1.jpg)
EMRsOnly Meaningful When They’re Usable
![Page 2: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/2.jpg)
Conflict of Interest Disclosure
Jeff Belden MDDr. Belden is on the faculty at University of
Missouri - Columbia, which has a contractual consulting relationship with Cerner for EMR research and development.
Dr. Belden has no financial interest.
![Page 3: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/3.jpg)
Adoption
![Page 4: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/4.jpg)
Adoption
What’s the friction?
![Page 5: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/5.jpg)
Acquisition Costs
• Lost productivity• Long training times• Rebellion
Poor Usability
Smelcer 2009
![Page 6: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/6.jpg)
What is usability?EMR
^
![Page 7: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/7.jpg)
Usability isEffectivenessEfficiencySatisfaction
ISO 2003
![Page 8: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/8.jpg)
Usability meansLearnableEfficientMemorableError-freeSatisfying
Useit.com
![Page 9: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/9.jpg)
Usability is…
![Page 10: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/10.jpg)
10 Principles1. Simplicity2. Naturalness3. Consistency4. Minimizing
cognitive load5. Efficient
interactions6. Forgiveness
http://bit.ly/UsabilityHIMSS
7. Feedback8. Effective use of
language9. Effective
information presentation
10.Preservation of context
![Page 11: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/11.jpg)
Simplicity
![Page 12: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/12.jpg)
For doing refills
For overview only
Simplicity
![Page 13: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/13.jpg)
Naturalness
![Page 14: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/14.jpg)
Naturalness
Old way – lots of drill-down clicking
![Page 15: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/15.jpg)
Naturalness
Better way we know the body already
![Page 16: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/16.jpg)
Consistency
![Page 17: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/17.jpg)
Consistency
Name and identifying info consistently placed
![Page 18: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/18.jpg)
Minimizing Cognitive Load
![Page 19: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/19.jpg)
Minimizing Cognitive Load
Exact past dates• This requires mental math
![Page 20: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/20.jpg)
Minimizing Cognitive Load
Relative past dates• Easier. No extra thinking.
![Page 21: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/21.jpg)
Minimizing Cognitive Load
Hover to see more detail• Have it both ways
![Page 22: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/22.jpg)
Efficient Interactions
![Page 23: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/23.jpg)
Dashboard efficiencyEfficient Interactions
![Page 24: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/24.jpg)
Efficient Interactions
50 Clicks…• 6 minutes
![Page 25: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/25.jpg)
Efficient Interactions
2 Clicks…• 1-2 minutes
![Page 26: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/26.jpg)
Forgiveness
![Page 27: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/27.jpg)
Forgiveness
Let users discover by exploring without fear of destroying
Let users recover gracefully from mistakes
![Page 28: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/28.jpg)
Forgiveness
A bad example…
![Page 29: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/29.jpg)
Feedback
![Page 30: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/30.jpg)
Acceptable
![Page 31: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/31.jpg)
Better
Please wait while we check 10,357
records…
![Page 32: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/32.jpg)
Best
Please wait while we check 10,357
records…
Time remaining… 8 seconds
![Page 33: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/33.jpg)
Effective Use of Language
![Page 34: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/34.jpg)
Plain English for patient
Terse for doctor
![Page 35: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/35.jpg)
Effective Information Presentation
![Page 36: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/36.jpg)
Effective Information Presentation
Sorted alphabetically, not randomly
Better yet, allow sort by other criteria, too
![Page 37: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/37.jpg)
Preservation of Context
![Page 38: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/38.jpg)
Preservation of Context
![Page 39: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/39.jpg)
Usability Methods
![Page 40: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/40.jpg)
![Page 41: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/41.jpg)
![Page 42: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/42.jpg)
Prototyping
![Page 43: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/43.jpg)
Prototyping
• Should look preliminary• Encourages user suggestions for
change
![Page 44: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/44.jpg)
Prototyping methods
• Paper• Simple wireframe• PowerPoint• Keynote (Mac)
• Interactive• Visio (Win) or OmniGraffle (Mac)
![Page 45: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/45.jpg)
Think-Aloud Testing
![Page 46: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/46.jpg)
Think-Aloud Testing• Let me record you as you
test/use my software.
![Page 47: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/47.jpg)
Think-Aloud Testing
Learn more• Read this book• Download the
instructions to do your own testing.
http://bit.ly/Dthink
![Page 48: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/48.jpg)
Test Early & Often
![Page 49: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/49.jpg)
Test Early & Often• Test 5 users, fix, repeat• Reduces need to rework later
![Page 50: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/50.jpg)
Watch UsersDon’t believe what we say we do• See what we do, instead.
User’s perception may be different from performance• “I failed to complete that task?”
Users may not know what we want until we see what’s possible
![Page 51: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/51.jpg)
Finding Users• Wander like Gandhi
• Collect them keep a Rolodex
• Go to their hangouts like Kinsey
![Page 52: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/52.jpg)
Emerging Trends
![Page 53: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/53.jpg)
CCHIT 5-star Ratings
![Page 54: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/54.jpg)
CCHIT Usability Testing• Gathering
baseline data• 9 products
tested so far (Jan 2009)
• Mean score = 4.4
– Too generous?
![Page 55: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/55.jpg)
AHRQ Research & Policy Agenda
![Page 56: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/56.jpg)
AHRQ Papers• EHR Usability: Evaluation &
Use Case Framework http://bit.ly/AHRQux1
• EHR Usability: Interface Design Considerations
http://bit.ly/AHRQux2
![Page 57: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/57.jpg)
Data mining user behavior
![Page 58: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/58.jpg)
Data miningCollect analytics data on EMR
users• Find patterns of difficult use• Find user errors• Do think-aloud test• Retool, retrain, or retrench
![Page 59: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/59.jpg)
Vendor-User Collaboration
in vivoIf the mountain won’t come to
Mohammed, Mohammed must go to the mountain
![Page 60: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/60.jpg)
Take the usability lab to the interruptive clinical
environmentNew technologies make this more
possible
![Page 61: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/61.jpg)
Webcams built-in WiFi
![Page 62: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/62.jpg)
Morae software records userface, voice, clicks, keystrokes, times
![Page 63: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/63.jpg)
Small, cheap, good video cameras
![Page 64: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/64.jpg)
Web capture from ASP model EMRs
![Page 65: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/65.jpg)
Social networking
![Page 66: EMRs: Only Meaningful When They're Usable](https://reader035.fdocuments.us/reader035/viewer/2022081602/5457c05ab1af9f33608b4f48/html5/thumbnails/66.jpg)
Want to learn more?• EMR Usability Principles and Proposed Testing
• http://bit.ly/UsabilityHIMSS
• Checklist - Evaluating EMR Usability before you buy• http://bit.ly/shopEMR
• HIMSS 2010• Session 57: • ARRA and EMR Usability: What Providers Need to
Know• E-Session 409: • EHR Usability: Pain Points Evaluation and Results