In health care, usability of software is a patient safety issue. It’s why Allscripts employs User-Centered Design (UCD) principles to gather clinician feedback on our solutions throughout the development process. A great example of this process at work is the recent adaptation of Allscripts Homecare™ to a mobile application.

Home health nurses are a specialized group, often traveling to patients’ homes to provide care. Despite the mobile nature of their work, there were not many mobile applications on the market when we started this effort. Our objective was to streamline their workflow and develop a version of Homecare that nurses could use on a tablet, instead of a laptop.

What we learned from “ride-alongs” with home health and hospice nurses

We started the project with ethnographic research, which means we rode along with more than a dozen nurses in the field. By observing their working environment and the challenges they face, we developed a set of guiding principles:

  • Reduce clutter – Only show the right information at the right time. Don’t clutter the interface with information and features that are geared toward another role.
  • Simplify navigation – Make it easy for nurses to understand where they are within the application, and how to access the information they want.
  • Improve reminders – The application should help the nurse understand when work is incomplete, or if there is documentation required to complete the visit.
  • Streamline documentation – At the end of the visit, assist the nurse with text to help document the visit, and create a straightforward way to document time and mileage.

We used the ride-alongs to inform our designs and do more user testing. We completed two formative studies: one to validate the overall navigation structure and vitals data entry, the second to view and edit information within the patient chart. During these tests, we gave participants a specific task set, and asked them to think aloud as they completed these tasks. Afterwards, they subjectively rated ease of use and usefulness.

We then conducted two formal usability tests: one tested for basic navigation, viewing and entering documentation, and the second tested the calendar, time entry and open charts functionality. For these tests, we instructed users to read each task out loud, then complete the task without talking or asking questions. Once again, users provided feedback about ease of use and usefulness of the application.

Qualitative and quantitative reactions to mobile application

We applied what we learned to design our mobile version of Homecare on a tablet. We addressed all of the guiding principles and received encouraging feedback, such as these comments:

  • “That was simple. Now that I know how to do this, I prefer this way over my current way of doing it.”
  • “I like the ease of use after becoming familiar [with the system]. It doesn’t look hard so it shouldn’t scare too many people. The [legacy application] is harder to learn than this. I can see our training costs go down…to none at all.”
  • “While I’m more familiar with what I have now, I could easily learn this and I would like it better.”

 Beyond qualitative comments, we quantitatively measured improvements, too. When compared with the solution on a laptop, we reduced the time it took for nurses to complete the workflow from 35.7 seconds to 27.7 seconds (22% reduction). We also reduced the number of clicks from 30 to 21 (30% reduction).

A user-centered-design process made it possible for us to launch Allscripts Homecare Mobile™ to the market in 2014. We continue to seek clinician feedback throughout our solution development process and look forward to keeping patient safety at the center of our efforts.

Editor’s Note: This is just one example of the rigor with which Allscripts designs and evaluates our products. The American Medical Association (AMA) and MedStar Health recently evaluated Allscripts alignment with best practices for user-centered design and testing. These organizations analyzed EHR vendors with a framework focused on eight user-centered design best practices. Allscripts Enterprise EHR (now called Allscripts TouchWorks® EHR) and Allscripts Sunrise™ Acute Care are two of the three technologies to achieve perfect scores, out of the 20 technologies evaluated. Read more here.

 

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About the author

Leigh McClure is a User Experience Researcher at Allscripts and has experience in many areas of research and product design including: usability testing, ethnographic research, focus groups, UI design, interaction design, heuristic reviews and more. She has a Bachelors degree in Bioengineering from the University of Pittsburgh and a Masters degree in Industrial Engineering from NC State University. She got her start with a small consulting firm and worked on the testing and user interface designs for a broad range of products from ovens to enterprise level software products. At Allscripts, she has worked on many products, including Allscripts Wand(TM), Allscripts Touchworks (R) EHR, Sunrise(TM) Mobile Care and for the past two years she has been doing research and design for the Allscripts Homecare(TM) Mobile application.

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