In reality, the International Organization for Standardization (ISO) is “an independent, non-governmental international organization with a membership of 163 national standards bodies”. In my daydreams, it is a sacred, mythical place where there are always an equal amount of doughnuts (with an set amount of sprinkles) for everyone in the breakroom, where there is no one who takes more time than anyone else drinking at the water fountain, and where everyone has decided on the exact amount of smile size, head nod angle and wave intensity for greeting colleagues (moderate, 35 degrees of vertical neck thrust, varying dependent on hallway width).
While they may not have agreed to that level of standardization, the wonderful folks at ISO have agreed on a standard definition of usability.
ISO standard 9241 defines usability as “the effectiveness, efficiency and satisfaction with which specified users achieve specified goals in particular environments”.
It defines effectiveness as “the accuracy and completeness with which specified users can achieve specified goals in particular environments”, efficiency as “the resources such as time, money or mental effort that have to be expended to achieve the intended goals” and satisfaction as “measured by the extent to which the user finds the use of the product acceptable”. Here is a good primer on the glorious ISO 9241.
Transforming Healthcare Usability
The healthcare industry finds itself in the midst of quite a usability-heavy moment, as it transforms itself from a fee-for-service to value-based care delivery paradigm. Customer relationships are changing at each level of the healthcare supply chain: from the patient who shops for healthcare products and services, to the clinicians who provide the healthcare product or service, from the solutions providers that support the delivery of that care to the insurance companies and governmental agencies that support the payment for those care products and services. The thousands of people that make up (scare quotes) “the healthcare industry” are all impacted by their own user experience with other products and services’ usability. Both in this nation and around the world, people throughout the industry are asking themselves how to best bring innovations and excellence in applying usability from other industries to their own segment of the supply chain, used to deliver healthcare products and services.
EHRA Talks Usability
On Wednesday, June 21, the Electronic Health Record Association held its 2nd annual Usability Summit at the 20F Conference Center in Washington DC. The goal of the meeting was to “provide cross-functional stakeholders the opportunity to share ideas and develop solutions to the varied and complex challenges that are faced by clinicians and other end-users and software designers in their efforts to build systems that effectively support workflows for healthcare providers in organizations of varying sizes and specialties.” I had the opportunity to attend the event, and here are a few thoughts on the theme of the event and the discussions that took place at it:
- The focus of the meeting was on the creation of personas representing the wide variety of stakeholders whose day-to-day activities are impacted by health IT. While much of the industry’s conversation about usability seems to focus on providers or patients, the discussions that took place during the 2017 EHRA Usability Summit focused on gaining a better understanding of the needs, goals, and frustrations of stakeholders like medical assistants, front desk staff, payers, regulators amongst others. In fact, as Ross Teague, Director of User Experience (and facilitator for much of the day), pointed out that when usability is optimized only for one stakeholder, such as a clinician the usability for another stakeholder, such as Hospital IT staff, will undoubtedly be impacted in unexpected ways.
- Great insight from the event’s keynote speaker, Dr. Kath Straub from Usability.org. A participant discussed that healthcare organizations, clinicians in particular, don’t often have time to devote to effective usability testing of the HIT they work with. Dr. Straub talked to the event’s participants about how “when an organization says they don’t have the time and money for usability testing, it means that usability is not one of their top priorities, which means that it is not one of the organization’s core values”. Good lesson for the industry to contemplate. If you say that usability matters to you, you need to devote the time and effort to work on it.
- Also discussed was the dance between security and usability, which is only going to get increasingly complicated over time. Developers are rightly expected to build a product that fluidly moves healthcare data around to other facilities outside of a given IT network in a manner that makes sure to keep the data protected from cybercriminals. Defining the trade-offs between better usability and better security will continue to evolve as a critical component of the HIT development process.
For A More Usable Healthcare System
Usability matters in healthcare because the effectiveness, efficiency and satisfaction of healthcare product and service delivery impacts each one of us on a cellular level. The care and maintenance for all of those brain, heart, lung, pancreas, etc. cells that define what we refer to as “our health” all depend on us receiving effective care that we are satisfied with and that is delivered efficiently. A more usable healthcare system is something everyone can agree on from across the political spectrum. A more usable healthcare system improves patient safety. A more usable healthcare system makes clinicians more satisfied with their ability to provide care. A more usable healthcare system saves money.
I’m for a more usable healthcare system. Are you?