Michelle McNickle, New Media Producer
5 keys to EMR usability
September 6, 2011
Usability: the concept is often at the root of slow adoption of EMR systems, and rightfully so. Although effective training and implementation methods affect user adoption rates as well, poor usability has a strong impact on productivity, error rate, and user satisfaction.
And usability should be considered more than just user satisfaction, according to Rosemarie Nelson, principal of the MGMA Consulting Group. The concept is far more complex, and to Nelson, it’s synonymous with workflow integration. “Too much attention is given to the number of clicks and screens, when what should be considered is how and when information is presented,” she said.
Dr. Steve Waldren, MD, Director of the American Academy of Family Physicians’ Center for Health IT, explained that when it comes to understanding usability, it’s essential to consider utility as well. “Usability is subjective in many ways,” he said. “It has to do with the functionality of the system. Utility is making sure the system does the things you need it to do.”
[See also: Usability key to wide EMR adoption.]
So what determines if an EMR is useable? Better yet, how can prospective users ensure a system won’t result in headaches over lost productivity? According to Nelson, the first step is to recognize no system is perfect.
“The problem for most providers is they, nor their vendor implementation team, look for that commonsense template: the one that fits a majority of patient visits, not the ‘perfect’ template that allows visits for all patients to be documented. There is just too much variation to expect 100 percent.”
With that in mind, here are five additional elements to consider when it comes to EMR usability.
Supportiveness: According to both Waldren and Nelson, the system should support workflow. “It’s not about a single user,” said Waldren. “It’s about an entire practice.” Waldren suggests presenting vendors with three clinical scenarios: the most common instances at a practice, the most challenging instances at a practice, and the most number of interactions among staff. That way, it’s evident how the system supports specific workflow. “I suggest doing two sets of the scenarios,” he said. “One that you present the vendor ahead of time, and the second during the demo. Then you can see the system’s flexibility to take care of each scenario.”
Flexibility: Nelson considers flexibility to be key, not just within the system, but also with those using it. “Usability is all about integrating a tool into a provider’s day,” she said. To illustrate, she suggests considering the evolution of the phone. “We started with one phone, then we add extensions,” she said. “Then, we came up with portable phones because our work is mobile. We found that we needed phones to follow us, not us having to go to the phone.” Since usability can become complicated, she said, the way a provider uses the tool might evolve as he/she becomes comfortable with improvements in workflow and operational efficiencies. Therefore, it’s essential to change how he/she interacts with the device and the software.
Continued on next page.
Showing 2 Comments
dch say: Good thoughts
September 21, 2011 | 18:07 PM GMT
Don't know who PJCasey75 is, but he (she?) seems to "get it."
My additional and strong opinion is of opposition to the feds mandating this premature mess into our offices now. Were EHR technologies among those we find to be worth the money, we'd already have been lining up to buy this stuff. The process by which the feds have taken it upon themselves to carrot/stick EHRs into our work is proof that it wasn't ready. If it was ready, we'd already be using it and nobody would be feeling paternalistic urges to shove it down our gullets.
Contrary to what disgruntled bean counters, techies and politicians allege, physicians are not Luddites. We have, historically, been extensive technology utilizers ... where it works, clinically and financially.
Give us something we want ... something we crave ... something we'll lust after ... and we'll line up outside the door before the shop opens to buy it, just like we did for the iPhone and iPad.
pjcasey75 say: Useability - Use for what?
The first question we all have to address is that this whole migration towards EHRs masks a greater change than just that of swapping one technology for another. We're not just changing how we document medical encounters, we're changing what doctors do.
Doctors used to keep notes (on paper) almost entirely for their own recollection. Whatever worked for them was the definition of useability.
We've already reached a point where the primary care provider is only one among many who lay claim to their medical documentation. In that sense, we've changed their job. The reason paper charts are no longer satisfactory is that we've changed the requirement - doctors must do more, record more, and do it in ways that satisfy a whole range of other stakeholders besides themselves. In that sense, they've lost a good deal of their traditional independence, and frankly, nobody likes that.
We're not migrating to EHRs for the sake of primary care providers. We're doing it because primary care providers already do a different job than they used to do, and we expect that change to accelerate even more in the coming days. They need different tools because, like it or not, they already have a different job than they used to have.
They're no longer merely examining a patient to determine the impression and plan. They are also responsible for reporting to a much wider world: 1) what it is that they've observed, 2) what's the plan which may include a whole cadre of caregivers, and 3) last but not least, how are they justifying the charges for the visit. That last bit has always been an irritation to traditionally independent, highly competent practitioners who have been trained and trained and trained some more. They, like any expert, don't appreciate being evaluated by anyone but their peers, and insurance claims processors are not considered peers.
One part of why EHR adoption is so difficult is that it is at this very point where doctors are being required to fully accept increased requirements for documenting and reporting on their practice. In some cases the reason it takes twice as long to document a visit is that we've asked them to document more than twice as much data (in a less "humanly" efficient but more "computerly" efficient data structure) than before.
In any industry users who are making a transition to computerized workflows experience a feeling that the new way is initially harder. That's because it is - because the computerized method requires more input than the "make your own notes for your own use". If we compare the two methods based only on such a limited concept of "useability", we miss the transformation that is going on here, and all sides of the argument for change also fail to understand why there is resistance. The computer system gets the blame for an entire sea change because it is the most hands-on incarnation of that change - but it's not the whole thing in and of itself.
The hope we hold out for this migration is that, as with any technology, the user community's participation will eventually make them qualified contributors to EHR technology improvements. EHRs will get better. And secondly, the long term benefits of EHR implementation which today sound suspiciously like the same old sales pitches we've heard for decades, will eventually be realized by users who, right now, can only see the pain.