EHR design requires user input, early and often

  • Ross Teague, Ph.D.
  • 04/07/2016

Adherence to user-centered design (UCD) best practices is key to improving electronic health record (EHR) usability. A recent white paper reviews UCD best practices, and how they help improve usability and patient safety.

Unfortunately, many EHR vendors skip a crucial step in UCD: formative testing. In this phase, software designers test early versions of the technology with actual users. They’re not testing completed code or solutions ready for market, but rather prototypes, wireframes or even early sketches.

Good formative testing is iterative, meaning designers must gather and address feedback from users several times before finalizing the software. To illustrate how the formative testing process works at Allscripts, here’s a recent example from our Allscripts Sunrise™ Ambulatory Care solution.

Example: Formative testing for a new task module

The Sunrise team conducted formative usability tests on a newly designed task module with six clinicians. The User Experience team held one-on-one, remote sessions with each participant lasting 60 minutes each. These sessions helped test a set of 10 specific measurable usability goals, such as “100% of users can view and acknowledge results.”

During each session, the moderator asked the participant to complete a series of tasks on a prototype. For example, one task was to find prescription refill requests for a patient and another was to view tasks assigned to the user.

The moderator observed how well participants were able to complete the task, recording reactions and recommendations for improvement. In this case, participants suggested using a different icon for the workflow manager that was more familiar and intuitive. The moderator then summarized the number of tasks completed and qualitative comments, and calculated a System Usability Score (SUS) from subjective user data.

Results: Users rate interface as more enjoyable and intuitive

Overall feedback on this prototype was positive. All physicians said they would like to use the new functionality, and they felt the workflow was better than the current functionality.

All but one measurable usability goal met or exceeded expectations. On average, users rated the interface 49% more enjoyable, 40% more intuitive, 36% better at giving the right information at the right time, and 70% “newer” and “fresher” looking than the current application. Users also averaged a 97% task completion rate and rated the application as very usable with a System Usability Score (SUS) of 87.

What’s next?

Learning that we didn’t meet one of the usability goals lets us go back and address the issue before the product launches. There are minor adjustments we can make to the Sunrise task module to make it even better. Allscripts will refine the design based on these findings and continue testing with Sunrise users.

The best way to keep users at the center of EHR design is to involve them early and often in the process. Involving them in a meaningful way will continue to improve usability.

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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 EHR design requires user input, early and often


Robert Jackson says:

04/17/2016 at 7:41 pm

Embed a suggestion “box” in every EHR page. You make it too hard for a busy physician to report.

    Ross Teague says:

    04/19/2016 at 11:07 am

    Thanks, Robert. A benefit of this type of feedback would be that vendors would get more context around the problem experienced. As you said, clinicians are busy and often the feedback about a usability problem doesn’t have as much detail with it that would be beneficial for really understanding what the problem is. Most times, the clinician doesn’t report the problem until much later and often it gets altered as it gets passed from person to person. A contextual “suggestion box” would help with these problems. Last year, the AMA also suggested something similar when they said EHRs should include an “automated option to provide context-sensitive feedback that is used to improve system performance and safety.” Allscripts is evaluating this as well as other methods for collecting feedback from clinicians that leads to improved products.


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