Last week I was invited to attend the second annual NIST forum for EHR Usability called “A Community-Building Workshop: Measuring, Evaluating and Improving the Usability of Electronic Health Records.” NIST, in collaboration with the ONC, unveiled its initial discussion points for what it might consider as the “Usability Criteria” in the upcoming Meaningful Use Stage 2 regulations. At the event I met with Dr. Melanie Rodney, Distinguished Researcher at Macadamian and a member of the HIMSS Usability task force; I was impressed by the work that she and her firm were doing in EHR usability space. At the NIST forum I was able to spend time with experts in the both the fields of EHRs (like me) as well as in usability and user experience (like Melanie). We learned that the government believes that while usability can be key in increasing product effectiveness, speed, enjoyment, etc., NIST is going to focus on EHR usability for the improvement of patient safety. I asked Melanie and Lorraine Chapman, Director of User Research at Macadmian, to share with us what we in the EHR technical community should do in light of what we learned at the NIST forum last week. Here’s what Melanie and Lorraine said:
While the specifics are still forthcoming, vendors have a window of opportunity today to get ahead of NIST – and ahead of competitors – by proactively addressing meaningful use in advance of the 2013 deadline. Let’s look at what vendors can do, combining the information NIST has given so far with fundamental usability best practices:
Step 1: Set Usability Goals related to Patient Safety
These are specific, measurable goals such as “Our EHR must provide a 99% error-free rate of medication entry”. NIST has given the following examples of use error categories, each of which might be driving 1 or more goals.
- patient ID errors
- mode errors [e.g., dose related]
- data accuracy errors
- visibility errors [e.g., tapered dose 80-20mg – 80 shows vs. 20]
- consistency errors [ e.g., pounds vs. kilos ]
- recall errors [e.g., 1 time dose]
- feedback errors [1 tablet vs. 1/4 tablet]
- data integrity errors [ next vs. finish to enter injection just administered]
Step 2: Identify Target (and Real) Users
The Stage 2 meaningful use criteria will require EMRs to demonstrate that they have tested their products’ usability with representative users. For hospitals, representative users will include nurses, and other allied health professionals in addition to physicians. For smaller clinics, the primary users may just be physicians, and nurses. Identify and categorize the key users of your product, then create User Personas to describe and the goals and motivations of each user group.
Step 3: Identify Critical Tasks
Isolate and describe the primary tasks that users must perform with your product. NIST has said that it will provide example lists of tasks and scenarios tied to MU criteria, but in general these should be the high frequency and high criticality tasks of your system. For example:
- Hospital critical task flow: nursing notes and common tasks such as administering medication and taking vitals
- Clinical critical task flow: the sequence of tasks centered around prescription and drug dosage
Step 4: Benchmark & Track
Focusing on the identified critical tasks, an initial usability test plan should be written and executed to benchmark the product’s usability status. NIST has said the testing should be performed with representative users performing the defined representative tasks, the moderator must have UX/Human Factors and clinical domain experience, and the tests must be performed in a simulation of real use environments [e.g., surgery, clinic, nurses desk, etc.]
Testing will give your organization quantitative data to measure and track specific usability metrics, and the ability to formulate very concrete goals.
Step 5: Build An Action Plan for Meeting Usability Goals
Once your measurable goals and related critical tasks are identified, and benchmarks are established through initial testing, it’s time to put a plan together for incorporating user-centered design into your product development process in order to measurably improve usability for patient safety.
The plan should establish the required investments and timelines to meet the goals, as well as what is required to achieve them, including related organization adjustments, such as bringing in qualified HCI personnel.
With this simple plan in place, vendors can already take action to get buy-in with their internal stakeholders and get their teams systematically identifying and improving weak points related to patient safety, in preparation for the final criteria to be announced later in the year.
For more detailed information about establishing software usability as part of your core development process, check out Macadamian’s white paper “Eight Usability Mistakes Your Team is Probably Making (And How to Fix Them)“.
Shahid N. Shah is an internationally recognized enterprise software analyst who specializes in healthcare IT with an emphasis on e-health, EHR/EMR, Meaningful Use, data integration, medical device connectivity, health informatics, and legacy modernization. He regularly shares information and insights on his blog, The Healthcare IT Guy.