From the Editor: What You Want vs. What You Get
We've come to recognize that EHR implementation and adoption is part art, part science, so say the clinical IT leaders who share tales of successful and less-than-successful deployments. In nearly all cases, physician buy-in is one of the top obstacles to electrifying the record process. Although culture change is a big factor in slow buy-in, usability is another factor, and one that's likely to gain more attention as more facilities implement EHRs.
As Clint vanSonnenberg writes in "EHRs: Getting to Meaningful Usability" on page 18, nuisances such as non-intuitive user interfaces and type that's too small can add up to wasted time, or worse—data entry errors that could affect patient care.
This issue isn't new. Formal usability testing, employing user-centered design processes and personnel with expertise in usability engineering are uncommon, according to an AHRQ-funded report released last year that looked at EHRs that entered the market from the mid-1990s through 2007. Unfortunately, there is evidence of usability re-engineering: Workarounds continue to challenge EHR-based ambulatory consultation systems, according to a study in the July 2011 issue of the International Journal of Medical Informatics. In the study, which followed up on research from 2009, the researchers found several examples of "shadow processes and tools" in computerized consult management. However, those workarounds could lead to product improvements if vendors pay attention, the researchers stated.
What does the future hold? Market forces will nudge usability along, as columnist Bill Bria opines on Page 24, but on the regulatory front, don't expect products to be certified for usability. Meaningful use requires that certified EHRs be capable of certain functions, not how easy it is to perform these functions. During the recent CMIO Summit Clinical IT Leadership Forum in Boston, Karen Bell, MD, MMS, chair of the Certification Commission for Health Information Technology (CCHIT), was asked if usability would be part of future certification for meaningful use. Her answer: No, because it's going to take a very long time to understand how to evaluate usability. This task is complicated by the wide variation in the care that organizations deliver and the EHR capabilities they need.
With certified usability not an option, we need partnerships between clinicians and vendors to breed more usable EHRs that embrace uniform user interfaces, consistent data entry points and fields and careful attention to clinicians' workflows. All will be good for business as well as patient care.
As Clint vanSonnenberg writes in "EHRs: Getting to Meaningful Usability" on page 18, nuisances such as non-intuitive user interfaces and type that's too small can add up to wasted time, or worse—data entry errors that could affect patient care.
This issue isn't new. Formal usability testing, employing user-centered design processes and personnel with expertise in usability engineering are uncommon, according to an AHRQ-funded report released last year that looked at EHRs that entered the market from the mid-1990s through 2007. Unfortunately, there is evidence of usability re-engineering: Workarounds continue to challenge EHR-based ambulatory consultation systems, according to a study in the July 2011 issue of the International Journal of Medical Informatics. In the study, which followed up on research from 2009, the researchers found several examples of "shadow processes and tools" in computerized consult management. However, those workarounds could lead to product improvements if vendors pay attention, the researchers stated.
What does the future hold? Market forces will nudge usability along, as columnist Bill Bria opines on Page 24, but on the regulatory front, don't expect products to be certified for usability. Meaningful use requires that certified EHRs be capable of certain functions, not how easy it is to perform these functions. During the recent CMIO Summit Clinical IT Leadership Forum in Boston, Karen Bell, MD, MMS, chair of the Certification Commission for Health Information Technology (CCHIT), was asked if usability would be part of future certification for meaningful use. Her answer: No, because it's going to take a very long time to understand how to evaluate usability. This task is complicated by the wide variation in the care that organizations deliver and the EHR capabilities they need.
With certified usability not an option, we need partnerships between clinicians and vendors to breed more usable EHRs that embrace uniform user interfaces, consistent data entry points and fields and careful attention to clinicians' workflows. All will be good for business as well as patient care.