New Note reflects user-centered design

We are working to improve our clinical documentation tool, Note. Caregivers use it to record encounters with patients, so it’s important that the tool is efficient and effective.

There’s always room for improvement. We’re paying close attention to how clinicians currently use and want to use the tool to help shape the next version, following a user-centered design (UCD) process.

The rise of user-centered design in Health IT

It has been around a while, but UCD has received more attention lately in the Electronic Health Record (EHR) industry. Meaningful Use Stage 2 requires suppliers to follow a UCD process to develop certain types of products.

UCD encourages engaging with users early and often. It emphasizes understanding their goals, requirements, context of use, and evaluating designs with users throughout development. UCD can help lead to better efficiency, safety and overall satisfaction.

We’re using UCD and working closely with clinicians to make sure we get the new version of Note right.

Engaging with clinicians at every stage of development

We incorporated UCD from the beginning of the development process for the new Note. Our team watched clinicians using their noting tools in their environments using ethnographic research techniques, and we conducted numerous interviews. This information helps us determine which features and interactions will be the most valuable.

EHRs live inside a dynamic, complex environment. Our research efforts also weighed technology, regulatory, cultural and financial factors (to name a few). As part of our UCD process, we identified specific performance metrics related to efficiency and safety that we use as design requirements. We’ll ultimately evaluate the product against these metrics, too.

Moving into the design phase, we built around existing patterns that had been tested by users in other products. We met human factors guidelines for intuitiveness, efficiency and safety.

Throughout the entire design process, we kept in close contact with users. We shared screen shots, held reviews with user groups, and had 1-on-1 sessions where we watched clinicians perform typical tasks with low- and high-fidelity prototypes.

What users can expect from the updated Note

We’re improving the new Note in three main areas. It will offer:

1. Better user experiences – The tool will encourage structured data entry, but it won’t make users feel boxed in. It will offer structured entry, free text and voice-to-text options in all sections. It will be easy to understand, following “WYSIWIG” principles (“What You See Is What You Get”), and enable personalization, such as favorites and default settings options.

2. A single web and mobility solution – The tool enables a single experience across solutions and devices. Users can input information using voice-to-text or touch.

3. Easier administrative maintenance – It will be easier to create content, and it will be easier to share it. Better, more accessible content helps support analytics and clinical decision making.

Stay tuned for information on the updated Note, which we expect to be generally available in the fourth quarter of 2013.

In the spirit of user-centered design, we’d love to hear your thoughts on what would most positively impact your day-to-day noting experience.

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About the author

Ross Teague, Ph.D., director of 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.

2 COMMENTS on New Note reflects user-centered design


Abby Francis says:

04/26/2013 at 10:44 am

A few things we would love to see:
Personalization per provider, an accurate e/m coder, more professional looking and consistent outputs (our providers are embarrased to send their current v11 outputs to referring providers,) for example, better spacing and formatting, perhaps the ability to edit the formatting at the user or admin level, the ability to have only problems/results etc that are relevant to the authoring provider’s scope of practice show in the note without having to cite needed or hide unneeded items in every note (for example, the ability to show only “my priority” issues, rather than just having them sort to the top and having to hide all other problems…or for only results that were ordered by the authoring provider to show, etc.)

Ross Teague says:

05/06/2013 at 12:50 pm

Your requests are right in line with what we’ve been hearing from other clients, and we’re working on adding these types of features. With personalization clients can change how the note looks so it fits their own tastes as well as reduce the clutter to make it easier to read and build. Feeling confident in how the note looks as well as being able to work efficiently are key design guides for us. We’ll be evaluating our designs throughout development to ensure that the personalization features/functions meet the needs of our clients.


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