If there’s one thing we know about EHRs, users hate clicks. And for good reason. Clicking and scrolling historically have represented extra time, effort and evidence of not understanding an efficient workflow. Click reduction is often cited as the best way to improve electronic health record (EHR) usability. Our gut instinct tells us that we should do everything we can to reduce clicks. Yes, unnecessary steps are annoying and should be removed. But we have to be careful that we don’t actually increase cognitive load, hinder decision making and reduce overall efficiency and satisfaction in our zeal to reduce clicks and scrolling. There is a great deal of research available that should guide the design, implementation and customization of EHR interfaces. In the evidence-based practice of medicine, scientific evidence should also guide Health IT usability decisions. Some of these known […]

0 comments

“Improve usability…but don’t change anything!”

  • Ross Teague, Ph.D.
  • 06/08/2016

Organizations and users in the Health IT world desire products with better usability and efficiency, but they hesitate to embrace changes to familiar interfaces and interactions. Humans don’t like change for many reasons. In Health IT, changes to interaction models, layouts and workflows can mean retraining, which costs money and takes time away from work. There are also concerns that users will be less efficient using something different, or that it will reduce satisfaction. Many times what we are comfortable with is not what is best for us, even though we have adapted to it. Users may not realize the physical, mental and safety “costs” of sticking to what is most familiar. While familiarity associated with software is often related to steps in a workflow, it can also be familiarity to icons, colors and layouts. Users may not see how a change in […]

0 comments

8 seconds or less: How physician input improved usability

  • Jeanne Armstrong, M.D.
  • 05/24/2016

Physician input is vital for good Health IT design. The only way we can continue to improve adoption, usability – and ultimately patient safety – is to engage users early, often and through all stages of software design. Involving users is one of the guiding principles of Allscripts’ user-centered design (UCD) process, the subject of a recent white paper. When building new products or improving existing solutions, we follow those best practices. Formative testing catches mistakes before it’s too late All too often, users don’t get a chance to weigh in until Health IT solutions are about to be released. But we take great care to conduct formative testing for our new features and solutions. This type of testing occurs with early versions of solutions, such as wireframes, sketches or prototypes. Designers hold one-on-one sessions with actual users. They provide […]

2 comments

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 […]

0 comments

Guiding principles for EHR design: A 10-point checklist

  • Jeanne Armstrong, M.D.
  • 03/22/2016

As one of the clinical architects of Allscripts TouchWorks® EHR, I work hand in hand with our functional architect, product owners and user-centered design (UCD) experts. We work as a team on new designs to make sure we’re using best practices to improve usability. We developed the following guiding principles as a checklist to help us better focus our product development on what users need: 1. Let users do their work when and where they discover it needs to be done. Reduce the amount of unnecessary clicks to complete a workflow. Design navigation and workspaces to enable users to perform a wide variety of tasks, while tailoring them for the most frequently performed actions. Where possible, free cognitive resources with automation. 2. Acknowledge chaos. Consider users who perform tasks in chaotic work environments, where interruptions are expected. Make it easy […]

27 comments

Why EHR usability has fallen short

  • Ross Teague, Ph.D.
  • 03/07/2016

A recent article said that electronic health record (EHR) usability is poor because clinicians are not the ones who are designing the products: “Physicians and other clinician users of electronic health record systems commonly rate the products low on a usability scale, in large part because non-clinicians do the bulk of the work designing them.” But does usability really suffer because non-clinicians are designing Health IT solutions? When we look at other industries, we don’t see end users primarily responsible for the design of successful products. For example, accountants don’t design banking technology, and writers aren’t developing word-processing software. Why do products in other industries seem to be more reflective of users’ needs? For EHR usability to improve, do clinicians have to create and design the products, or is there another more impactful way for them to be involved? I […]

In my previous post, I didn’t address much of the industry discussion about Electronic Health Record (EHR) usability:  What, exactly, is usability in the first place?  How do you measure it? How do you improve it? These questions are important for a couple of reasons: First, usability is a critical requirement for any software and should be a main focus of development. Second, the Office of the National Coordinator (ONC) is establishing policy to attempt to improve EHR usability, making it a regulatory issue as well. Here’s some background on the second point for context.  When the government passed ARRA to help fund Health IT adoption, a primary issue raised by the healthcare community was that Health IT systems have many usability issues. So – as many people posed – if the government was going to mandate EHR adoption, shouldn’t […]

That was one of the key questions raised in Tuesday’s Health IT Meaningful Usability Summit 2012 in Washington, DC, part of National Health IT Week.  The summit attracted representatives from government, academia, payers, healthcare IT vendors, and non-profits. I was there representing Allscripts, where I serve as Director of User Experience. The summit attendees focused on a handful of key points related to usability:  safety and usability; radical industry transformation; open and modular systems and data; and a consumer focus in Health IT.  Let’s take a quick look at each of them in turn before I return to that headline. Safety and usability Dr. Jacob Reider, the acting Chief Medical Officer for the Office of the National Coordinator for Healthcare IT (ONC), and a former CMO of Allscripts, gave a presentation on usability of health IT that focused on safety.  Dr […]