UPA Boston discussion of EHR Usability

1. Usability of Electronic Health Records: Interactive Discussion on How to Make Electronic Health Records Usable Kris EngdahlLauren ZackKaden RushfordTrisha FlanaganJannis Brea

2. UX at athenahealth Who is athenahealth? We’re a cloud-based solution for practice management, electronic health records, and patient communications, serving physician practices Our deep service offerings are based on proprietary web-native software, a continuously updated payer knowledge-base and integrated back-office service operations. User Experience introduced to athenahealth in 2008 Backed by CEO, embedded in R&D processes, tackling really interesting UX problems Has grown to a team of 14, providing: User experience design User research Product copy The company and the team are still growing (Come talk to us!)

3. Why is EHR Usability such a hot topic? Healthcare is a large industry $2.5 trillion, 14.3 million jobs, 17.3% of GDP It affects all of us We are all once and future patients We pay for everyone’s healthcare, either through insurance or taxes Recent healthcare reform legislation encourages the adoption of EHRs HITECH act includes incentives for “meaningful use” of EHRs Government is discovering the field of usability as it evaluates EHRs Healthcare providers are demanding better EHR usability “It doesn’t look like it’s built for me” (system model != user mental model) Better ease of learning Better efficiency of use Poor EHR usability can put patients at risk

4. Discussion:How do we define EHR Usability? What is an electronic health record (EHR)? Electronic version of paper charting, plus capacity for electronic data exchange; managed by healthcare professionals Used by single-physician practices, large healthcare networks, and everything in between Different from a personal health record, which is managed by the patient What is usability? (Choose your definition – here is the NIST definition) ISO 9421-11: “The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use.” Discussion: How do we define “usability” specifically re: EHRs? What does it mean for an EHR to be usable? Where does patient safety fit?

5. How do we apply User Centered Design to the development of EHRs? Essentially, just like any other UCD Process: Start with users Iteratively design and test Collect data after deployment And yet…there is something different about this arena Let’s discuss this, piece by piece

6. Discussion: Starting with users Who are the users of EHRs? Characteristics Knowledge Context Goals Tasks What dimensions apply to the user population? How do we scope / carry out user research?

7. Discussion: Iterative design and testing Who do we test with? Who are “representative” users? How do we get unbiased access to them? What do we test? Most EHRs are highly customized for individual practices. How useful is a test of a “generic” version under development? What tasks do we test? What data do we use for testing? Participants are always distracted by unrealistic data – so it has to be realistic Real data is protected by HIPAA

8. Discussion: Collecting data post-deployment What kinds of summative evaluation are appropriate? Can you compare usability of different EHRs? How? Summative testing? With whom? Using what? What tasks? What contexts? Surveys? Expert reviews? Expert in what? Same questions as with testing – tasks, contexts?

9. References General info on healthcare industry: http://www.bls.gov/oco/cg/cgs035.htm http://www.bnet.com/blog/healthcare-business/health-spending-hits-173-percent-of-gdp-in-largest-annual-jump/1117 What’s an EHR? http://www.ama-assn.org/ama/pub/physician-resources/health-information-technology/health-it-basics/emrs-ehrs.page Government documents on EHR usability http://www.cchit.org/sites/all/files/CCHIT%20Usability%20Testing%20Guide%20Ambulatory%20EHRs%202011%20v6.pdf http://www.nist.gov/itl/hit/upload/Guide_Final_Publication_Version.pdf http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_907505_0_0_18/09(10)-0091-2-EF.pdf http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_907504_0_0_18/09(10)-0091-1-EF.pdf Information on EHR usability and patient safety http://www.bmj.com/content/330/7491/581.full http://www.useit.com/alertbox/20050411.html http://www.jointcommission.org/sentinel_event_alert_issue_42_safely_implementing_health_information_and_converging_technologies/