ONC's Reider: 'Usability is not where it needs to be'

BOSTON--“Usability is not where it needs to be,” admitted Jacob Reider, MD, the Office of the National Coordinator for Health IT’s chief medical officer, speaking about health IT at the Medical Informatics World Conference on April 28.

Much of the latest technology aims for a pleasurable experience, he said, such as autocompletion of texts and the user interface of the iPhone, which anticipates users' needs. However, “maybe it’s not safe.” For example, the autocomplete function could incorrectly finish the name of a drug. “Safety is an important component of usability. We want users to derive pleasure but it’s more important that they be safe.”

Physicians might complain that technology is too slow, but Reider said that could be a good thing. “Sometimes slow is better,” especially when it forces users to double check their selections.

Reider also addressed the gap between quality measure expectations and EHR capabilities, which he deemed quality chasm 2.0. The paper record allowed for searches of certain information, he said, but while EHRs probably contain the information they can be more difficult to search. “To fill that gap, we need to change where we are in terms of availability of information.”

He used the example of whether heart patients have been prescribed aspirin and whether they have actually taken the aspirin. “Maybe we should expect that the patient got it but let’s not look for exceptions. That’s different from how quality measures have historically worked.” Changing the expectations could expand EHR capabilities, he said. Providers can work with developers and vendors on elements that are essential. 

"When we create digital records and pretend to anticipate all the needs of clinicians, we make mistakes," Reider said. "We think we’ve anticipated all the questions that can be asked but we really can’t and then we destroy the usability."

Standardized data input lets users build “incredibly creative things," he said, "but at a granular level we haven’t been explicit about how to capture data.” For example, there are many ways blood pressure is captured “which means its semantic value is variable. If we settle on a core subset, I would argue, explicitly captured in a standardized way, then we can start to grow the complexity of the systems but only then.”

The document-centric record is what’s holding us back, Reider said. Thinking of healthcare as a series of observations that can be grouped or batched is one way to get away from the document model. But, “we like what we know.”

When it comes to the questions of what matters and to whom, “patients need to be driving the bus,” he said. The “shift left”—away from hospital care toward greater patient engagement—leads to increased quality and lower costs, he said. The greater flow of information means that primary care providers now have access to evidence-based care that “used to be trapped between the ears of specialists.”