What if US healthcare providers dramatically adopted EMRs in increasing numbers, worked hard to achieve meaningful use, but never benefited financially or in efficiency or quality?
Meaningful use will be dependent on adequate EMR usability. Discover how usability relates to a number of meaningful use criteria. We offer a usability checklist to assist providers in shopping for a new EMR, or to use during implementation of an existing EMR, in order to achieve efficiency, effectiveness, and usefulness.
Presentation to HIMSS 2010 with co-presenter Janey Barnes PhD.
2. Conflict of Interest Disclosure
Jeff Belden MD
Dr. 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.
3. Conflict of Interest Disclosure
Janey Barnes PhD
Contracted Research:
• Allscripts,
• Patagonia Health,
• Duke Health Systems
56. Meaningful Use (MU)
5 Health Outcome Policy Priorities
1. Improve quality, safety, efficiency, &
reduce health disparities
2. Engage patients & families
3. Improve care coordination
4. Improve population & public health
5. Ensure adequate privacy & security
protections for personal health information
57. Meaningful Use (MU)
We picked 3
1. Improve quality, safety, efficiency, &
reduce health disparities
2. Engage patients & families
3. Improve care coordination
4. Improve population & public health
5. Ensure privacy & security protections for
personal health information
58. MU > Improve Quality
1. Improve Quality…
1. Evidence-based CPOE
2. Clinical decision support at the Point-of-
care
3. Registries for patient outreach
59. MU > Quality > EBM CPOE
Evidence-based CPOE
…building ruts to quality & safety
examples…
65. MU > Quality > CDS at POC
Clinical Decision Support
at the Point of Care
examples…
66. MU > Quality > CDS at POC > Problem List
Problem Lists
Usability principles
1. Simplicity
2. Naturalness
3. Effective use of language
4. Effective information presentation
67. MU > Quality > CDS at POC > Problem List > Simplicity
Simplicity
68. MU > Quality > CDS at POC > Problem List > Simplicity
The old way...
69. MU > Quality > CDS at POC > Problem List > Simplicity
Better way
70. MU > Quality > CDS at POC > Problem List > Naturalness
Naturalness
Sort & sequence like clinicians think
Not by diagnosis code.. … but alphabetically
71. MU > Quality > CDS at POC > Problem List > Naturalness
Effective use of language
Common ways you could display Diabetes 250.00 (ICD-9)
Just use words physicians use
What would Dr. Jesus say?
72. MU > Quality > CDS at POC > Problem List > Info Prez
Effective Info Presentation
Sorted alphabetically Sorted for cardiology
73. MU > Quality > CDS at POC > Problem List > Info Prez
Effective Info Presentation
Highlighted for cardiology Filtered for cardiology
74. MU > Quality > CDS at POC > Alerts
Alerts
Usability principles
1. Simplicity
2. Efficiency
3. Effective information presentation
75. MU > Quality > CDS at POC > Alerts > Simplicity
Too busy visually…
76. MU > Quality > CDS at POC > Alerts > Simplicity
Try to find the essence…
77. MU > Quality > CDS at POC > Alerts > Simplicity
All the doctor needs to see
78. MU > Quality > CDS at POC > Alerts > Simplicity
Simplicity
79. MU > Quality > CDS at POC > Alerts > Info Presentation
Effective info presentation
Show only what the physician
wants
• Severity
• What is the adverse effect?
• Alternative actions
80. MU > Quality > CDS at POC > Alerts > Feedback
Efficient interactions
• Prevent repeated alerts for same
combo
• Prevent alerts for low-level danger
• Let user adjust alert level
81. MU > Quality > CDS at POC > Lab
Lab results
Usability principles
1. Effective information presentation
2. Minimize cognitive load
3. Preservation of context
82. MU > Quality > CDS at POC > Lab > Info Presentation
Effective info presentation
old
new
83. MU > Quality > CDS at POC > Lab > Min cognitive load
Minimize cognitive load
84. MU > Quality > CDS at POC > Lab > Preserve context
Preservation of context
Compare to prior lab, two year graphical trend
85. MU > Quality > CDS at POC > Lab > Preserve context
And what medication is he/she on?
And what is the weight and BP doing?
87. MU > Quality > CDS at POC > Problem List
Quality Registry: Dashboard
Usability principles
1. Efficient interactions
2. Effective information presentation
94. MU > Engage patients > Clinical summary
Effective Language
Plain English
95. MU > Engage patients > Clinical summary
Efficient
And
something
for the
wallet
96. MU > Engage patients > View lab on web
Viewing lab results on web
Usability principles
1. Effective use of language
2. Effective information presentation
97. MU > Engage patients > View lab on web
Viewing lab results on web
98. MU > Engage patients > View lab on web
Effective Language
Change ”Reference” to ”Normal Range”
99. MU > Engage patients > View lab on web
Effective info presentation
What would patient expect to find?
•Highlight unviewed results
•Abnormal in color
•Doctor’s annotations to explain
100. MU > Engage patients > View lab on web
Effective Info Presentation
Easy to misunderstand “which normal range”
101. MU > Engage patients > e-Copy
Web Access or e-Copy
Usability principles
1. Naturalness
2. Forgiveness
104. EMR Buyer’s Guide
Shopping for usability
Before you buy, or implement…
105. MU > Before you buy
It’s a process…
Define what’s Important to You
• Evaluate your alternatives
• Select the alternative that is best for your
team
106. MU > Before you buy
What’s important to you
Effectiveness
•What do you want /need from your EMR?
•How will this product meet those wants / needs?
•See barriers when you try the product?
107. MU > Before you buy
What’s important to you
Efficiency
•What outcomes should be better
• Faster
• more robust
• have better payoff
108. MU > Before you buy
What’s important to you
Satisfaction
•Of which users?
•For which key tasks?
•In which clinical setting or environment?
109. MU > Before you buy
Evaluate Your Alternatives
What do your friends say
• Ask, ask, ask!
• Go watch your friends at work on their EMR
• with their actual patients.
• not a demo in the office.
• watch others while you are there.
110. MU > Before you buy
Evaluate Your Alternatives
What do your colleagues say
• Blogs, etc.
What do your professional groups & others say
• KLAS
• AAFP
• Your state’s academy of …
111. MU > Before you buy
Evaluate Your Alternatives
What do you and your team say
• Do your own evaluation
• Create 3-5 primary care clinical scenarios
• Time critical tasks in those scenarios
• Set targets that you want
• A few users rate qualitative aspects of the
software with 5-point scale
• Evaluate reporting functions
112. MU > Before you buy
Creating Clinical Scenarios
1.Choose ones that matter
• frequent, important
• Include prescribing
• Include “hey-doc” request
2.Test them
3.Look for efficiencies
• e.g. document normal ROS with one click
113. MU > Before you buy
Buyer Beware
Try Out the Reporting Function
• What will you want to report?
• A1Cs in diabetics
• BP control rates in hypertension
• List of patients on a particular recalled drug
• Should be easy
• Look for efficiencies
• Out of the box experience
• Easy to make reports quickly
114. MU > Before you buy
Buyer Beware
Don’t be “wowed” by Templates
Don’t be impressed with installed templates
• Try them out first
• Try to make one yourself (with no training)
Don’t expect clinicians to create or edit
• Try to make some
• Ideal: Easy to make on the fly.
• Even a caveman (a physician) can do it!
115. MU > Before you buy
Buyer Beware
Training
• Touch on initial training
• you & staff will be overwhelmed at launch
• Demand later training
• after you have the basics down
116.
117. Want to learn more?
• EMR Usability Principles and
Proposed Testing
• http://bit.ly/UsabilityHIMSS
• Checklist - Evaluating Usability in an
EMR before you buy
• http://bit.ly/shopEMR
118. ARRA & Usability: What Providers Need to Know
Questions?
Janey Barnes PhD | jbarnes@user-view.com
Jeff Belden MD | beldenj@health.missouri.edu
119. Want to learn more?
• EMR Usability Principles and
Proposed Testing
• http://bit.ly/UsabilityHIMSS
• Checklist - Evaluating Usability in an
EMR before you buy
• http://bit.ly/shopEMR
Janey Barnes PhD | jbarnes@user-view.com
Jeff Belden MD | beldenj@health.missouri.edu