A look inside Epic's EHR design and usability teams

Healthcare IT News traveled to Epic’s campus to learn how the company thinks about design and usability. Takeaway: Health IT is hard. One vice president even said if she wanted an easier job she could just go to Facebook. 
Epic EHR design usability

VERONA, WISCONSIN — Janet Campbell is a software developer and vice president of patient engagement at Epic Systems.

In that role, she is focused on patient portals and engagement features but also on home health and telemedicine. That means working closely with the usability team as well as the standards and interoperability experts.

Campbell and other Epic developers — notably Sumit Rana, Epic’s senior vice president of R&D — work with clinicians toward the end goal of enabling doctors and nurses to interact with patients in a way Campbell described as focused and friction-free.

Programmers doing fieldwork
“Anything and everything we now develop, whether it’s for a doctor, scheduler, caregiver, we’re always thinking how would a patient be a consumer of this information, and how would you think about that end-to-end thing,” said Rana, who in his early days at the company led the development of Epic’s MyChart patient portal.

Rana recounted working at a client health system in Chicago back in 2001-2002, when he had first started at Epic, and spending four nights in the ICU observing workflow.

“Until then I sort of knew what people wanted us to do,” Rana said. “I knew the features we wanted; I knew the technical components. But I did not get ICU – what it means to be in an ICU.”

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Rana had to be there to understand what the care providers needed to effect the best care for patients, what their workflows were, how they went about their work.

As a result of these early on-site observations, in fact, Epic formalized the program requiring every developer to spend a minimum of four days and up to 18 days testing their applications in the field.

As Rana sees it, fieldwork helps Epic developers understand not only the technical and functional pieces, but it also enables them to view their technology through the eyes of providers and patients. Real-world users, in other words.

“I think what it teaches programmers is to care,” Rana said. “Because when you see someone struggling with something, it really bothers you, and you want to come back and say, ‘How would I do this so it functionally is doing what the user expected – how do I make it more intuitive?’”

Shadowing clinicians and appealing to patients
Under Epic’s program of developers spending time in the field, they follow clinicians as they work, listen to how they speak with one another and to patients, and gain a better sense of the types of reports caregivers write.

“It helps you get the lingo,” Campbell said. “There’s some stuff you can learn from a textbook, but a lot of what you can learn is by observing activities such as the corner cases, and what happens when everything doesn’t go according to plan, and how can you tell if everything doesn’t go according to plan? How can you recover from it?”

Campbell, who has worked on applications for cardiology and also with a team developing obstetrics technology, tries to see herself as a medical student, and reads a lot of medical textbooks. It doesn’t replace the shadowing, instead it augments her understanding of what’s needed.

“If anything, when you’re designing for a patient you have to be even more focused on usability,” Campbell said. “Because we’re talking about a wider spectrum of users, we absolutely need to understand their goals and objectives because that’s where usability comes from.”

Rana added that the core expectation of developers is they have to understand the domain – and not only understand it in the context of what users expect the software to do. “That’s sort of an obvious given thing,” Rana said. “You have to understand what their life is like.”

[Inside Epic: Judy Faulkner refutes rivals' claims about Epic EHR being closed

And then there is the ongoing challenge that every technology company faces of figuring out exactly what users want and delivering that. Then doing it again. To help on that score, Epic employs physicians, nurses and pharmacists to help design the software, and the company also takes input from customers through dedicated focus groups, steering boards and hands-on usability labs.

Rana pointed out that patients’ expectations today – and those of clinicians, too – are sculpted by their experience at the Apple store, JC Penny and travel websites as well as technologies they use everyday outside of work.

“Patients expect that experience,” Rana said. “So that’s part of what we’re focused on as well.”

To that end, Rana and colleagues at Epic sometimes don T-shirts displaying the slogan: “My code saves lives.”

'Health IT is hard'
Healthcare IT is probably one of the toughest industries for programmers, Campbell and Rana said.

“There are so many different variables that can go wrong. There are these societal pressures,” Campbell said.  

Campbell acknowledged that she could have a simpler job developing software at a less-demanding company or a sector with softer consequences when mistakes are made than the price paid for medical errors.

"If I wanted to have an easy job, you know,” Campbell said, “I could go be a software developer at Facebook.” 

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

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