Role of Usability and Adoption in the EHR

Transcription

1 Role of Usability and Adoption in the EHR Design Matters! Don Rucker, MD, MS, MBA Vice President, Chief Medical Officer Siemens Medical Solutions USA An educational presentation to the EHR SIG June 13, 2008

2 Design Matters! Let s take a look at EMR s from a designer s point of view But let s also assume the designer is a physician Why is EMR design hard??? Page 2

3 Why is EMR design hard? Medical biologic variation is huge 2-4 million points of variation in the our genomes between SNP s and copy number variations Documentation is not just documentation Also a bill to be submitted to payors Also a legal document in malpractice suits Soon a quality metric Lots of deep workflow issues Page 3

4 Deeper intellectual issues Medical knowledge cannot be represented in a closed form fashion Vocabulary is unsolved and may be insoluble Medical knowledge and thinking are accelerating while our version control strategies are not Most documentation is tied to H & P thinking Page 4

5 Practical issues ''Watch what we do, not what we say'' Page 5

6 Physicians know what they want? Interesting question Physicians designing for physicians Focus groups & validation Not really as it turns out => much of what we do is subconscious or so heavily pre-compiled as to be nearly so Page 6

7 So what can you do? How can you solve the EMR design problem? Attacking the design problem from the top Attacking the design problem from the bottom Attacking from the top murky Attacking from the bottom well described Page 7

8 Attacking from the top Mental Models Mental Models of practitioners are different than what they were taught think about writing an admission note or a set of admitting orders Mental Models are hard in that they require keen minds with breadth of experience Embed thinking and workflow Page 8

9 Attacking from the top Thinking about mental models Think about lots of scenarios New patient vs. old patient Short notes vs. long notes Single morbidity vs. multiple co-morbidities What is easy and what is hard Be honest with yourself We read only a tiny bit of what is in front of us Page 9

10 Attacking from the bottom The Microsoft Office problem Software UI s (drop down menus, scrolling list boxes, buttons etc.) are heavily dominated by office work thinking Office work Paper manipulation dominated Deskbound Large variety of tasks Few interruptions Page 10

11 Attacking from the bottom The Microsoft Office problem Locked in by GUI building tools in software libraries Locked in by programmer familiarity, programmer education, and ironically enough by UI experts You can escape! Screens can be medical task specific not trivial though Page 11

12 Attacking from the bottom So you have a series of top-level concepts (or a product you are about to buy!) What tools can you use to thinking about usability? My three tools for looking at medical software Reading Load how much reading? Navigating Load how many screen and concept jumps? Thinking Load do I have change the way I think? Page 12

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17 Tricks to the bottom up analysis READING, NAVIGATING, & THINKING LOADS Clinical terms or not Icons vs. reading vs. icons with text Target size Target movement Common tasks vs. secondary tasks Where are you? What are you doing now? the view from the door Scrolling list boxes tool of the devil Page 17

18 Conclusions Think hard about usability in systems you plan to buy Mentally try multiple patient and workflow scenarios in systems you are considering Use the tools of top-down (mental model) and bottomup (reading, navigating & thinking load) It s actually OK to type or use simple text templates Page 18

19 Great design It can be done! Page 19

20 Thank you! For more information, please contact HIMSS Staff Liaison JoAnn W. Klinedinst, CPHIMS, PMP, FHIMSS at Page 20