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Expect chaos: Why we designed our EHR for interruption

As a physician who practices in an urgent care setting, I know what it’s like to be interrupted all day, every day, while trying to use an electronic health record (EHR). To have to leave one screen to deal with an urgent message or lab result, then try to navigate back to where I was to finish my documentation – workflow challenges are abundant.

At the end of most days, I have to spend another hour to catch up on documentation. I understand why physicians avoid steps that take three or four extra clicks, because over the course of a day with 30 patient visits, those clicks add up. Worst of all, poor EHR usability is more than frustrating; it is a patient safety issue.

Thinking like our users

Like most clinicians, I’m concerned about EHR usability. I’m part of a team that’s working to continuously improve Allscripts TouchWorks® EHR. Our team – including clinicians, user-experience designers, product owners and functional experts – works closely with our clients through user groups and our provider advisory board.

We adhere to best practices for user-centered design (UCD), a process to improve our software and make it easier to use. In fact, TouchWorks EHR was one of only two solutions to earn a perfect score in an American Medical Association (AMA) and MedStar Health evaluation of alignment with best practices for user-centered design and testing.

One of the reasons we are proud of our improved UCD processes is that we do both formative and summative testing of new software releases. Some vendors rely on summative testing, which is the kind you do at the very end to gauge how well users understand the software. But if these tests identify a problem, it’s often too late or costly to fix it.

We conduct formative testing with our users in a one-on-one meeting, using prototype solutions, and throughout the development processes, as ideas take shape. We did a lot of formative testing for the newest release of TouchWorks EHR, 15.1. Formative testing with users identified design flaws and gave us the opportunity to alter the design for a better product

As a clinician, I help ensure that the scenarios we test are clinically realistic and relevant, to maintain our credibility with clinicians. For example, we could ask clinicians to test scenarios with patients who have two diagnoses and three medications. But the reality is, with the prevalence of chronic diseases, clinicians often have to treat patients with multiple diagnoses and sometimes dozens of medications. Testing with real-world scenarios leads to clinically sound and relevant design choices.

Reducing interruptions to the user’s workflow

Many of our recent releases have had a large regulatory component, but this time we were able to focus on a lot of usability improvements. We’re excited to address some of our clients’ most frequent enhancement requests that will help users be more efficient when using the EHR, for example:

1) More efficient response options for alerts – Let’s say I get a warning message about allergies while documenting a patient visit. Instead of having to close the message and find the allergy history section, I can now update allergies directly from the message and continue my documentation. There are similar options for other alerts, such as duplicate problems.

2) Faster documentation with text macros – Users can now design a block of text and trigger it in the application with a simple text string or typing the name of a macro. For example, a nurse could use three or four keystrokes to insert a common set of instructions or contact information.

3) Saving time with in-line chart viewer – Previously, chart notes and result documents would open in a new window making it difficult to view these items and your current documentation. Now, users can see the chart and document while the chart is open, which is a huge time-saver when verifying and results and creating visit notes.

Of course, there are many more features in TouchWorks EHR 15.1. We’re consistently working to make it easier for users to navigate, sort and read information to ultimately enable better care – one patient at a time. Because we’ve designed these workflows expecting chaos that the real world brings, I believe our tools are going to be even more indispensable to clinicians. Contact us to learn more.

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About the author

Jeanne Armstrong, M.D., is director of solutions management for Allscripts TouchWorks® EHR and is a practicing physician at Hendricks Regional Health Immediate Care (Avon, Indiana, U.S.A.).With more than a decade of experience in healthcare IT, Dr. Armstrong has in-depth knowledge in EHR training, system configuration, content development and change management. Dr. Armstrong is board certified in Family Medicine and Clinical Informatics and completed her family medicine residency at St. Vincent Hospital in Indianapolis, Indiana. At St Vincent, she designed and facilitated a physician training program and support process for a community-based academic medical center with four (eventually five) residency programs, overhauled workflow and content to create a paperless immediate care, developed system content for multiple specialties, and helped facilitate an electronic data conversion between competing EHR systems. Dr. Armstrong earned a Certificate in Clinical Informatics, Clinician Leader from Indiana University, earned her medical degree from Indiana University School of Medicine, and holds a bachelor’s degree from Franklin College of Indiana.

1 COMMENT on

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Eric Quinones MD says:

01/10/2016 at 2:57 pm

Jeanne…it is so key as you point out to apply formative & summative methodologies under the UCD directive. From the MU experience and how that “squirrel distracted” development of truly engaging and functional UX for clinicians is a road I hope no one goes down again. Strong work! Q

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