One of the biggest objections to the adoption of an <a href="/directory/electronic-medical-record-emr" target="_blank" class="directory-item-link">EMR is its usability (or lack thereof), which is no surprise considering the ease of its predecessor: paper. Thankfully, there are a few ways to make your system not only more bearable, but significantly easier to use.
“There are several guidelines that have been published, [and each] cover particular OS, whether it be Mac, Unix, or Windows,” said Bob Hunchberger, a clinical informaticist for a 500-bed hospital. “If your application will be deployed in the PC world, it’s important that you adhere to the standards that are implemented in the Windows world. Why? Because Microsoft has ‘trained’ its users for more than a decade what behaviors to expect from applications that run in that environment.”
Hunchberger suggests five practical ways to make your EMR more user friendly.
1. Use appropriate controls consistently. Placement is everything, said Hunchberger. He suggests controls that initiate actions be near the top left, while those that complete actions near the bottom left. “Placement and behavior of the ‘OK,’ ‘Cancel,’ and ‘Apply’ buttons is important,” he said. “Users look for them in the bottom right. The three buttons have a consistent behavior of accepting the user’s response and closing the dialog, canceling the response and leaving the dialog, and accepting many responses without leaving the dialog. Placement is crucial in a top-left-bottom-right reading/scanning society.” Additionally, Hunchberger pointed out controls that appear in different locations or placements are distracting. “From dialog to dialog and page to page, the behavior should be the same; users expect it,” he said. “They become confused and frustrated when they invoke an action, and it doesn’t do what they’ve come to expect from hours of experience with Windows Office products or Windows programs at home.”
2. Standardize task sequences. Hunchberger said the system should be consistent with how users complete tasks, whether it’s left to right or top to bottom in dialogs and pages. “Controls that initiate tasks should be located at the top left, and the workflow should follow a logical sequence from top to bottom,” he said. “Don’t have the user start at the bottom, then move to the top, then back to the bottom – if the task is too complex, use multiple pages or a wizard, but be consistent in how the user completes the task.” Completing the task, he continued, should involve the same “button grammar” and placement, so the user quickly learns the process and isn’t distracted or interrupted. “The user shouldn’t have to say to themselves, ‘On this page, I need to start at the bottom and work up,’” he said. “Or, ‘On this page, the final action button is on the left.’”
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3. Reduce the users’ workload and memory requirements. This step is vital to completing tasks quickly, said Hunchberger. “This is what computers are supposed to do—what’s the value if the user has to write something down to be entered later?” Don’t require the user to hold things in their memory when shifting from one task to another. Instead, said Hunchberger, if the application requires a weight or height, use the units most familiar to the user and provide fields with the necessary conversion. “At the very least, permit the users to enter a value and click a button to show the conversion, but don’t stop there,” he said. “Carry it into the data field, if that’s required.” This applies to weight, height and temperature, said Hunchberger: three of the most frequently entered values that require conversion. “Provide shortcuts to enter today’s date or current time,” he added. “Don’t require the user to enter the current date or time every time [they’re] required. Provide tabbing support, so the user can navigate to fields and controls, without having to leave the keyboard.”
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4. Place important items at the top of the list or in alphabetical order for easy scanning. When using lists or providing the user with choices, said Hunchberger, think about how the list will be used. For example, in some cases, alphabetical is better, while in others, "most frequently used" works best. “If you’re required to document the source of the information you’re obtaining, and the list contains the words ‘patient’ and ‘parent,’ alphabetical would be a poor choice because most of the time, the source of the information will be the patient, not the parent,” Hunchberger said. “The word ‘patient’ should appear at the top of the list.” On the other hand, he continued, when filling in address information, listing states alphabetically would be best. The same can be said for check boxes and radio buttons. “Place the most frequently chosen items at the top or toward the left,” he said.
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5. Maintain its ease of use. Always avoid horizontal scrolling when possible, since users don’t like to scroll unless they have to, advised Hunchberger. Additionally, size the window or page appropriately, or use dynamic resizing. “When providing text messages in response to warnings or alerts, use 80 characters or less, so the message will actually be read,” he said. When it comes to warnings, use the appropriate icon in the warning dialog, which is an exclamation mark, he added. “Provide the user with enough information so they know how to remediate. Only use this when there is potential loss of user work or data.” Lastly, Hunchberger suggests using a question mark icon in dialogs in which a user needs to make a choice about something nondestructive, and use the red “X” icon when the user can’t proceed with or complete an action due to a system problem. “For errors and warnings, use an appropriate negative command button, such as ‘Close’ or ‘Cancel,’ versus ‘OK.’”
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