In a world where all certified EMR systems may be equal in terms of functionality needed to get organizations to Stage 1 Meaningful use, usability may be the differentiator that separates the good from the mediocre. But how do purchasers know if the systems they’re buying are “usable?”
Robert Schumacher, Ph.D., managing director of User Centric, a Chicago, IL-based user experience research firm, says that one way purchasers can assess usability is to include someone who has knowledge of human performance and usability in the procurement process.
“It’s helpful to involve someone who knows what questions to ask the vendors, i.e. what sort of organization and process do they have in place to test and measure usability, what have they done to improve the user interface, and what processes do they have in place to uncover and repair user interface issues that could be fundamentally important to patient safety,” he tells Inside Healthcare IT. “Just like you would include a security expert or an interoperability expert in the selection process, you should include a usability expert, too.”
While usability, or lack of it, has been discussed by clinicians for years, Schumacher says that up until now, resources to help them evaluate usability have been scarce. User Centric conducted a content analysis a few years ago, looking at 60 Request for Proposals for EMRS. It found that only one third of the documents had any guidance about usability and only a few had serious guidance about how to assess usability at all.
In response, User Centric published a white paper (http://www.usercentric.com/publications/2009/02/05/how-select-electronic-health-record-system-healthcare-professionals-can-use) that gives purchasers some insights about how to select a usable system. Additionally, HIMSS has created a section on Usability on its website with a document for evaluating usability (http://www.himss.org/content/files/HIMSS%20Guide%20to%20Usability_Selecting%20an%20EMR.pdf). Schumacher says he’s starting to see efforts from other professional organizations as well.
“There’s often a bit of a caricature painted about what usability is and I think that there’s not a solid enough respect for the knowledge base that surrounds it,” he says. “We’re not going to get as far as we could until there is a better appreciation and understanding for what we know about human performance and how that can be applied to user interface design and measurement of performance.”
Not paying attention to things like usability can have serious financial implications for healthcare organizations. “When you implement an EMR without being thoughtful, your labor costs can go up pretty dramatically,” says Marsha George, principal of Consulting by George. “Those labor costs are clinicians and they’re expensive.”
Schumacher agrees. “I think that that the most expensive part of procurement is the human capital. If we did as much due diligence on the user interface part of the system as we do on other parts, we’ll be ahead of the game.”
While vendors have the ultimate responsibility for ensuring that their systems are usable, Schumacher says that at some level, clinicians have to put some skin in the game, too. “An EHR is not an ATM,” he says. “Doctors shouldn’t expect to use a complex application the first time they sit down. I truly think that sometimes, doctors’ expectations may be too high for what’s realistically achievable.”
But he doesn’t give vendors a pass either. “That being said though, almost every EHR I look at violates some really fundamental user interface design principles. Just correcting a few of those will make a huge difference.”
Schumacher says that while there are companies who spend a lot of time crafting the customer experience and do it well, many don’t.
“There are ways to listen and work that are better than others,” he explains. “You’ll hear some of the vendors say they have a physician advisory panel or have focus groups. That isn’t user-centered design. That’s looking at utility. In our world, design begins in the field to understand what the user needs and their capabilities.”
When vendors concentrate on getting actual user experiences during the design process, rather than relying on focus groups, the feedback is likely to be more valuable. “It makes a huge difference whether you’re dealing with what someone says in a focus group or what they do in a one-on-one situation sitting down using the application documenting an office visit. I tend to believe in what people do and not what they say,” says Schumacher.
Designing software systems with usability in mind is smart business and health information technology vendors that take a thoughtful, strategic approach to usability will have a competitive edge in the marketplace.
“Several studies have shown that the cost of building usability into the front end of a development cycle is more cost effective than trying to build it in later. And in today’s marketplace, usability is a differentiator,” Schumacher says.
But building usability goes beyond merely adding to the existing system, says Gavin Lew, also a managing director at User Centric. It involves a strategic approach that some vendors, at least until recently, haven’t embraced.
“Throwing more usability at systems that were built to do billing and documentation is only going to make a more usable billing and documentation system,” Lew says.
While he applauds the efforts that are being made by vendors, he contends they constitute only half of the battle. “You can use a system as you’re required to do, but to use it really well but the key to making EHR and the other Obama healthcare initiatives really work is to have good rich data in the system. In order to do that, we have to evaluate why we want it to be more than be a good billing and documentation system.”
Copyright 2012 Algonquin Professional Publishing, LLC