Co-director, National Center for Cognitive Informatics and Decision Making in Healthcare at the University of Texas Health Science Center at Houston
Associate dean for research, professor, UT Health School of Biomedical Informatics
Principal investigator, ONC’s SHARP program for patient-centered cognitive support
In your research so far, what have you found to be the most challenging – the toughest nut to crack?
The toughest nut to crack for us is to get the EHR vendors to work on their products’ usability systematically. Only a small number of EHR vendors have their in-house team doing EHR usability. Most EHR vendors do not do that systematically. They may do that informally here and there, but have not spent effort to do that systematically.
So usability has not normally been part of their routine in terms of developing their products?
Some EHR vendors think that usability is common sense, and that everybody can do it. They don’t realize that it is a profession – just like an architect. It needs to be done systematically and by professionals, of course, who are doing this as their job. Other vendors simply dismiss it altogether and have the impression that it is subjective, not scientific and not useful. For other vendors, they do want to do it, but they do not have the budget to do it. From our perspective we know that what we do here is to view usability as a science. Actually, it is a scientific field built on many years of research and practice in many other fields. The toughest task for us is to convince the vendors to do it. This is especially good timing because, for the Stage 2 meaningful use, usability may be part of the certification. If this happens, it will give vendors more incentive to do it now.
How much of your research involves talking with physicians on what works for them and what doesn’t?
We work with them almost every day, and that’s part of the method to do things right because you have to work with the real users. We work with them in different ways. We observe them in a real clinical setting like the ED, the practice site, ICU and other places. We do interviews. We do surveys. And also, we bring them to our lab to do testing. What we are hearing now is that they do not like the data entry part of EHR. Almost all of them are saying the entry slows them down dramatically and makes their task less productive. Others are concerned about patient safety, making errors here or there. On the other hand, they all like the information retrieval part. They can get documents and data for their patients at their fingertips. So that’s a big upside.
Based on your work to date, what part of the EHR design is most lacking?