Usability is not a new concept and has been part of the healthcare discussion for several years. Healthcare solutions offering intuitive user experiences reduce clinician burden and decrease task time. Strengthening this usability, however, is still challenging. It requires us to engage our users in meaningful ways that enable them to provide actionable feedback.
The complexity of the health IT domain has evolved and now requires a deeper, more thoughtful approach to how and when we involve users. How users interact with systems is not only determined by what EHR vendors deliver, but also by how a site has configured the system. A study published in JAMIA shows variability in configuration can affect a user’s time on a task, number of clicks and error rates. To address this, implementation processes can start incorporating usability principles similar to software design.
To create an optimally usable system, and address user needs, there are a few key ways vendors should work with users to better understand the system’s actual usability.
Involve users early
The key to improving quality and safety, as well as clinician satisfaction, is enabling clinicians to work along natural workflows. Laying out data and functions in a way that makes sense to clinicians reduces cognitive burden and enables uninterrupted focus on patient care.
The most effective way to achieve this is to get users involved in the design process early on. Usability testing — through having users perform a series of tasks via a prototype of the design — helps ensure the design will meet user needs before it’s built. In giving their input on designs, clinicians are able to engage with systems, go through workflows, catch issues early and give feedback on what’s confusing to them and what works well. Clinicians are often excited to participate and their input is invaluable.
Through hands-on clinician testing on an Allscripts-developed tasking module, we increased the module’s score on the industry standard System Usability Scale from 36 to 87, out of a possible 100. Usability designed with active end-user input is destined for success.
Conduct usability testing customizations during implementation
Implementation decisions can have a huge impact on system usability for clinicians. Deployment and customization processes should incorporate usability principles similar to those of software design.
Vendors have a major role to play in laying out workflows that address their application’s most common uses. They can also provide customizations on EHRs and other systems, so users can personalize them to their own needs the way they do other applications. Implementation teams should engage users early and often to make sure their decisions will match what clinicians need. Users should be engaged at all levels of the implementation process to make their workflow needs known.
Similar task-based testing should occur before go-live. Finally, vendors need to streamline the upgrade process to make it easier for customers to take advantage of new functionalities. Many times improved workflows don’t make it to the clinicians for a couple of years, prolonging user frustration.
Focus on outcomes
Successful user design isn’t focused on adopting specific features, but on creating specific outcomes through those features. Customers and users who recognize which outcomes are most important to them (e.g., decreased cognitive burden, improved processes and fluency, or saving time documenting to gain more time spent with patients) can direct conversations with their vendors this way.
Vendors need to understand the why as well as the end state of the system and should be testing their software accordingly. As adding features to existing systems can cause further challenges for users, it’s essential every feature address a specific need and contribute to a determined outcome. Measurable usability goals should become common language between vendors and customers, and vendors should show how they are meeting these goals. These outcomes, through increased usability, can have long-term impact on the quality measures and financial health of the organization.
Improving the usability of EHRs is not easy and won’t happen overnight. Incorporating users in the the process will accelerate the improvements and ensure we are making incremental changes, both in developing our products and implementing them.