Measuring, Evaluating and Improving the Usability of Electronic Health Records Lana Lowry National Institute of Standards and Technology llowry@nist.gov
What is Usability? Usability is "the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use" - ISO9241
Why Does Usability Matter? Usability means that the people who use a product can do so quickly and easily to accomplish their tasks Usable Health Care IT systems can offer: More effective health promotion Efficiencies of scale in improving health and reducing disparities More effective use of information technology
How to Achieve Universal Usability? Design tools to support tasks, not complicate them Design for universal usability so that doctors and other medical professionals Do not have to worry about the tools Focus on their job and their patients Apply an evaluation process to Determine success and failure by the degree to which users are able to achieve high accuracy and error-free performance
Methodology Rooted in Human Factors Science Concerned with addressing the facts through the application of human factors principles, knowledge, and techniques (system science) Agnostic with respect to the implementation of the methodology Builds on methods employed by myriad human factors evaluation programs, in and out of government Focus on critical (potentially related to patient safety) aspects of usability
NIST Mission and Role in Health IT Accelerate standards harmonization in Health IT Develop test methods to assess compliance with standards Ensure universal usability of Health IT Focus on accessibility to prevent health disparities Develop usability and accessibility guidelines Determine specific objective criteria for usability evaluation
NIST Technical Guidance NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records (NISTIR 7741) Customized Common Industry Format Template for Electronic Health Record Usability Testing (NISTIR 7742) Human Factors Guidance to Prevent Healthcare Disparities with the Adoption of EHRs (NISTIR 7769) Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records (NISTIR 7804) A Human Factors Guide For Usability Of Critical User Interactions For The Pediatric EHR (NISTIR 7865) www.nist.gov/healthcare/usability
ONC-NPRM for MU Stage 2 Safety Enhanced Design A significant first step toward improving overall usability is to focus on the process of User-Centered Design (UCD) Prioritized eight certification criteria and associated capabilities to which this proposed certification criterion would require UCD to have been applied. We chose these eight because we believe they pose the greatest risk for patient harm and, therefore, the greatest immediate opportunity for error prevention and user experience improvement. EHR technology developers documenting that their UCD incorporates all of the data elements defined in the Customized Common Industry Format Template for EHR Usability Testing (NISTIR 7742). This documentation would become a component of the publicly available testing results on which a certification is based http://www.healthit.gov/providers-professionals/meaningful-use-stage-2
The IOM Report The National Institute of Standards and Technology (NIST) has been developing guidelines and standards for usability design and evaluation Usability guidelines and principles focused on improving safety need to be put into practice. - Institute of Medicine, Health IT and Patient Safety: Building Safer Systems for Better Care, 2012