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.
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Ease of Learning/ Naturalness: Is the system burdensome and clunky? To be sure it isn’t, Nelson suggests providers take a close look at how they interact with their nurses when using the EMR in the demo. This goes for both patient encounters in the office and on the telephone, as well as incoming documentation, like test results and correspondence. “If it appears cumbersome or redundant, [physicians won’t] achieve the intended benefits because [they] just won’t use those features,” she said. “The best way to observe and understand the dance between nurse and provider is by taking a trip to see the EMR in operation at a practice.” Both the nurse and the provider should visit the site, said Nelson, to fully experience the change they’ll have to adapt to in their own office setting.
Effectiveness: Although an EMR’s effectiveness to streamline workflow is obvious when considering its usability, Waldren said providers should also consider the changes taking place in healthcare. “The current is based on volume: patients, procedures, etc.,” he said. “Patients aren’t connected. The future is value-based and consumer directed. Clinical data will be used to measure quality.” With that in mind, Waldren says it’s essential to find a system that will effectively straddle both worlds.
Efficiency: To Nelson, an EMR should save time, and even the smallest aspects of a system could mean wasted hours. However, some EMRs do a good job of allowing a nurse and a provider to easily work on the same computer station with fast log-out/log-in. “This keeps the active patient online to allow for the concurrent work of the provider and nurse. Even something as simple as keeping the electronic chart ‘open’ on the desktop can be a boon to workflow; a nurse or provider is often in one patient’s chart when a phone call interrupts their work, and they need to open another chart. But, of course, they don’t want to lose the one they are working on.”
One thing is for certain when it comes to EMRs and their usability: it’s an evolution that’s essentially controlled by the user. “EMR usability must evolve similarly in that as we try to use it within our day, we can see where improvements can be made,” said Nelson.