EHR usability

By John Halamka
02:24 PM
EHR usability

In my recent Top 10 EHR Barriers blog, I identified usability of EHR software as a key issue.

It appears that NIST, with ARRA funding and ONC guidance is doing something about it.

This Sources Sought request is to identify organizations with the capabilities to accelerate usability testing and guidance. Specifically:

1. Tasks, Users, and Systems Research Component

a. Perform cognitive task analysis of the health care delivery task environment

b. Determine user characteristics

c. Perform human factors analysis of representative sample of existing HIT systems

d. Develop hypotheses about critical HIT design features

e. Evaluate hypotheses with usability testing 

2. Organizational Usability Processes Research Component

a. Study existing HIT industry usability practices

b. Investigate current usability evaluation methods being used in healthcare information technology as well as other areas

c. Conduct a workshop of acknowledged experts in HIT usability and have them analyze the findings of steps 2a and 2b.

d. Using the recommendations of the experts in step 2c and the principles identified in steps 1a through 1e, create a well-defined usability evaluation process that includes a roadmap for implementation and indicates where policy decisions are required.

e. Evaluate a representative sample of HIT systems using the evaluation process developed in step 2d

f. Develop a common format for HIT formative and summative usability test reporting

3. Development Methodology

a. Define, develop, and scope requirements.

b. Define and develop the project approach and description.

c. Adopt and refine methodologies following standard usability engineering principles.

d. Define and manage organizational requirements.

e. Perform cognitive task analyses and develop user profiles.

f. Conduct human factors analysis of systems and do hypothesis testing.

g. Identify existing usability practices in HIT development.

h. Organize and facilitate HIT usability expert workshop.

i. Develop, refine and harmonize usability and certification principles and frameworks.

j. Provide documentation and communication.

There is not yet a solicitation for funding, but I'm confident that funding opportunities will be announced soon.

Usability must be a key aspect of the national EHR program. Clinicians note that current products are hard to use/learn and this lack of usability can lead to errors. Senator Grassley's investigation of the current state of EHR products is in part related to usability issues.

My own experience is that usability is journey. Several years ago when the Joint Commission asked hospitals to implement medication reconciliation for all transitions of care, my development groups built innovative software that leveraged inpatient, outpatient, ED systems, and Surescripts/RxHub medication history to support the process. It took us a year to get the usability right by engaging stakeholders, studying the workflow, and iteratively revising the user interface. Only after extensive usability improvements did the application get deployed and adopted.

I welcome the NIST work and hope that we can develop objective usability metrics as part of the certification process. Software should be capable and usable to qualify for certification.

John Halamka, MD, blogs regularly at Life As a Healthcare CIO.