How User-Centered Design Can Improve EHR Usability
By Ross Teague, Ph.D., Director User Experience Research, Allscripts
The healthcare industry is increasingly calling for a design overhaul of electronic health record (EHRs) to improve usability. Why do products in other industries seem to be more reflective of users’ needs? I believe usability lags in health IT because EHR vendors have not applied rigorous, user-centered design (UCD) methods. It’s not that clinicians haven’t been involved, they just haven’t been involved in a meaningful way.
UCD is a process in which software designers give extensive attention to the needs, wants, and limitations of end users. It focuses on making the product fit user needs and wants, rather than forcing the users to change behavior to accommodate the product. A recent white paper reviews best practices and illustrates UCD concepts with examples.
5 Key Components Of Best-Practice UCD
EHRs help improve patient safety in several ways. Unfortunately, poor usability can increase errors that affect patient safety. For example, a Joint Commission analysis found human-computer interaction problems were to blame for one-third of patient safety events. To improve usability, it’s important to practice all five key components of best-practice UCD.
- Client Profiles: Know Who Your Users Are
The first step in UCD is developing a deep understanding of the people who will be using the solutions. It’s important to watch them work, listen to their problems, needs, and goals, as well as understand the environmental impacts. Really knowing the users can help guide decisions and prioritize features throughout the development processes. In later stages of UCD, these profiles can help identify the right people to participate in formative and summative testing. If your user is a healthcare consumer, it is imperative to understand their goals and abilities in the same way.
- Usability Metrics: Define How You Measure Success
An important step in UCD that often gets overlooked is to set specific, operationalized usability goals that design teams can track throughout the development process. These measures can be objective (e.g., time on task, clicks, errors) as well as subjective. An example of a common subjective evaluation in usability is the System Usability Scale (SUS).
- Patterns And Standards: Build Solutions Based On Known Research
Good design leverages human factors and cognitive psychology principles derived from evidence-based understanding of human performance, cognition and accessibility. Additionally, there are standards specific to Health IT available to design teams related to the presentation of clinical data, use of color in a display and much more.
- Formative Testing: Collect Regular Input From Users
In-depth, task-based formative user testing is a hallmark of UCD. A trained moderator conducts an evaluation of the product with users, typically in one-on-one meetings, using a variety of levels of product fidelity (e.g, sketches, lists, wireframes, and prototypes). These sessions happen throughout the development process and involve small numbers of users.
Gathering feedback early and often enables teams to identify design flaws while there is time to address them before making the product publicly available.
- Summative Testing: Evaluate The Final Product With Users
The final step prior to product launch is summative testing. This step involves having a large number of users evaluate a real-world version of the product. The focus is on task completion (e.g., pass/fail, time on task). A summative testing report is the only UCD step required to achieve Safety-Enhanced Design certification from the ONC. Unbiased, trained moderators conduct these tests before launching it to the market.
EHR Usability Is A Patient Safety Issue
UCD is a critical component in software design. At its core, a good UCD process is about involving users early and often, and using proven patterns in software design. EHR vendors must be vigilant when it comes to UCD; patient safety is at stake.
About The Author
Ross Teague, Ph.D., director user experience research, leads the cross-functional team that provides user-experience (UX) and user-centered design (UCD) support for Allscripts. His team provides the research, design (conceptual and detailed) and evaluation necessary for the UX needs. Ross also manages the Allscripts effort to meet Meaningful Use UCD requirements and update of our development process to include UCD activities and measures. Prior to joining Allscripts, Ross was partner and director of research at Insight Product development, a design and strategy firm specializing in the planning and development of medical devices. Prior to Insight, Ross worked as a human factors psychologist in a business and design services group at Intel, helping to develop internet based products for companies outside of Intel. Ross holds a Ph.D. in Applied Cognitive Psychology and Human Factors.