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EHR usability is suddenly front and center, now that usability testing is part of thecertification criteria for Stage 2.
We talked with diverse industry insiders for their take on what is critical to user-centric design and what the usability factors might mean to healthcare and to the healthcare IT market. Here is a sampling of some of the topics on their minds.
- Data entry. The biggest complaint is data entry, says JiaJie Zhang, director of the ONC’s SHARP project, charged with finding ways to make EHRs easier to use. “Nobody wants to become a data-entry clerk,” Zhang says. “Their job is to take care of patients, and data entry so far is not optimized. It involves many, many issues here. It is basically the repetition. If you enter this one here, you have to enter it again in a different place. It should be automatic.”
- Errors. “There is unprecedented interest in EHRs by physician community – driven by meaningful use – there’s no question about that,” says Robert Tennant, senior policy advisor for the . However, physicians are worried they might select a product that turns out to be hard to use, and take away from the time they spend with patient, he says. “I really think it’s a good step for ONC to start pushing the vendors toward more user-friendly systems," he adds, "because if they’re not easy it slows the clinician down. It can frustrate them. It could lead to errors."
- Metrics. “When you’re measuring, there are all sorts of things you can measure,” says Mary Kate Foley, vice president of user experience at healthcare technology company athenahealth. “First of all one of the advantages that we ( ) have that I keep forgetting other vendors don’t have is that we are in the cloud, so we can actually inspect how people use the system – just the way Amazon is inspecting what does it take to get you to click that add-to-my-cart button, or what does it take to get you to start using one-click shopping. So you measure who is doing what and how many people are doing that and how often they do it and how long it takes them. Those are usage metrics. They won’t tell you a thing about why somebody clicks something or whether they were happy or sad when they clicked it. The happy, sad and the why metrics? You get from usability inspections."
- Training. William F. Bria, MD, CMIO of Shriners Hospitals for Children, points to not only the short time for implementation of new EHRs, but also the short time for training on new systems. “Now we have this problem of compressed timeline for education and adoption. We have an imperfect (and that’s being generous) technology environment and market. We have systems that were made in response to customers and business opportunity that often had little to do with clinical adoption and acceptance – they had everything to do with IT adoption and acceptance, they had to make sense first to the IT leaders. And so here we are.
- Bottom line. One of the top complaints Rosemarie Nelson has gotten used to hearing from physicians is that EHRs slow them down. Nelson, principal of the MGMA Healthcare Consulting Group, doesn't buy it. “After they give themselves time to get over the curve – and that can be from three weeks to three months to almost a year for some of them – their bottom line is better," she says. "What they haven’t done is look at that change in their day. They think it takes longer to see one patient.” In the past they would write their notes at the end of the day, she adds. Now, they tend to enter notes during the visit. "When you look at data, the bottom line profitability for the most part is better," says Nelson. As for whether some EHRs are easier to use then others? “I think the market is the final test of usability.”