Macadamian Blog

EHR Usability Workshop to Address the new NIST Usability Criteria

NIST, in association with the ONC, has released a Electronic Health Record usability evaluation guide called Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records. This is expected to be the first step towards a series of criteria in the upcoming Meaningful Use Stage 2 program.

EHR Usability Workshop

To help vendors understand and proactively address the NIST EHR usability criteria, Macadamian is now offering a Meaningful Use Usability Workshop for developers of EMR solutions that focuses on the use error criteria established by NIST to improve patient safety. In this interactive workshop with key members of your product development team, Macadamian’s usability research experts will help you develop a formal usability assessment plan. Working together, you will explore and establish the key components of a usability action plan. These include:

• A Usability Strategy: Macadamian will help you to develop a business case and concrete plan of action to meet the NIST requirements with a view of upcoming meaningful use requirements. We will walk you through the 7 key criteria of the EUP [EHR Usability Protocol] and their implications for your product[s]. We will work with you to select and adapt the appropriate usage scenarios/workflows provided by NIST for your clinical users.  

• Patient Safety Goals and Benchmarks: Following software usability best practices, Macadamian will help you to uncover the specific usability goals that will underpin your products’ differentiation. Employing the 8 Use Error categories defined by NIST we will describe how to set and attain achievable targets for usability. These goals will lay the foundation for the benchmarking and tracking of your product’s current usability status and future usability improvements.

• Action Plan and Timelines: Macadamian will help your team determine next steps and progression timeline.

  Register Today Our one-day EHR Usability Workshops are offered at our new Silicon Valley lab, or can be held on-site at your facility. For more information and to register for a custom workshop, please contact:

Didier Thizy
Director, Healthcare Division
613-739-5976 x136
didier@macadamian.com

Hiring a UX Designer - Part 1

Many of our customers are starting to build a user experience design team. The challenge is - if this is your first hire, and no one on the hiring team has a user experience design background, how do you make the right hire?

As someone who has hired dozens of interaction designers, user researchers, and visual designers over my career, I can tell you it isn’t easy. While experience certainly helps, with the following guidelines and an acute BS detector, you’ll do ok. In this two part series I’ll share with you my five tips to help you make your first UX hire a success:

Poor UX in Ford Sync sinks Ford in JD Power

One of our beliefs at Macadamian is that user experience and software quality are intertwined. To the end-customer, a poorly designed UI creates the impression that the product is of low quality, even if the code is well crafted and well tested. Likewise, poor engineering and quality control (bugs, crashes, etc) create a very poor user experience. Now, the quality and the user experience design of the software embedded in everyday objects - cars, appliances, etc. - are influencing customer's perceptions of the overall quality of the product. 

Witness this year's JD Power's automotive quality ratings - the automotive industry's go-to guide on initial vehicle quality. Despite making huge advances in overall build quality, interior design, ride quality, and ergonomics,  Ford dropped from a 5th place ranking to 23rd. Why? Customers complained that Ford's new in-vehicle entertainment system, Sync, and MyFord Touch, are buggy, overly complex, and hard to use. I'm one of those customers - my Ford Flex is a wonderful vehicle, but if I try to use the voice recognition to turn on the radio, Sync turns on the air conditioning. The drop in ratings shouldn't be a surpise to Ford or anyone in the industry - the same thing happened to BMW a few years ago with their much maligned iDrive system. 

What's the lesson? Same as always:

1. More overall attention to design - especially some concept testing with real users - would have uncovered most of the issues with the latest version of Sync. 
2. Err on the site of fewer features. Typically there are only a few your customers will really find valuable and use daily. Packing features into a product just because you think they are cool is so 90s.
3. You always have to be willing to cut or delay a feature that simply isn't market-ready, no matter what you have invested and how much you've hyped it. It almost always comes back to bite you. 

A little knowledge is a dangerous thing: Poor research and its cost to EMR redesign.

We've talked in the past about the importance of research in improving a product's user experience and usability. In the healthcare field this is especially critical. Thankfully we see more and more companies engaging in getting user feedback. Unfortunately, since research is a highly specialized skill set, we are also seeing a proliferation of mistakes and misinterpretations in some of the more technical aspects of research, being made by people who don't have specific training in usability research or a general foundation in experimental practices. Here are 3 of the most common.

Misunderstanding Statistical Significance
We often come across clients who either ask for more data points, so its "statistically significant" or believe they have a meaningful result because it is "statistically significant". While research methods like surveys demand a certain amount of rigor with regards to statistical significance, when it comes to usability testing or observation of specific behaviours, it is not at all a sufficient criteria (although can be related) for meaningful or "proper" research. So how many research participants are enough? Well, that depends...on the range of target user groups, scope of activities or tasks you want to observe, how the results will be used and how many rounds/iterations of research you will be conducting. If you are iteratively testing an application or web application and only have to worry about one or two user groups, several iterations with 5-6 users each time will detect most of the usability issues. However, if you are doing a benchmark study, you'll want to run a greater number of users, across all user groups, to ensure the results are comparable.

How to design EHR patient progress notes… an ongoing debate

Quite a bit of our current work regarding EHRs has concerned the use of patient progress notes; sometimes also referred to as visit note.  “A patient progress note is a clinical document… describing a patient’s status and the physician’s assessments and care plan for the patient.” (Wilcox et al 2010).  In order to construct a progress note, the clinician must acquire, review and comment on various aspects of the patient’s data (e.g. lab results, information from medical rounds, medications, procedures, tests, etc.) so that they may determine the health of the patient and what to include in the current note (Wilcox et al 2010).

How are progress notes documented?

Currently, there are a few ways in which progress notes are created:

Clinical templates: these are pre-formatted notes which provide a standard protocol for documenting specific conditions.  These notes are “point and click” entry or keyboard entry based on likely problems that a patient may have (McKesson 2010).  Sound simple?  Not for all.  “It’s not easy to document everything that occurs during an office visit by clicking boxes” (Schumacher and Lew 2010).

Dictation: some physicians continue to dictate progress notes despite successful transition to an EHR because of familiarity.  Drawback of this format includes the fact that the data may not be available for reporting purposes and “transcription services sacrifices the financial return on investment of using an EHR" (McKesson 2010).

Voice recognition: voice recognition seems like a viable alternative which helps reduce the need for keyboard entry but also comes with its own concerns (McKesson 2010).

So what’s the problem? 

Most EHR applications are database-oriented (symptom, diagnosis, treatment, and then billing) which do not conform nicely to the complex and varied practice of medicine.  EHR's force the health providers to change how they write a progress note and what many EHRs end up doing is complicating things by adding unnecessary step or elements that get in the way.  It has also been stated that “the progress note, though once helpful, is now the single biggest hindrance to physician efficiency in the use and adoption of the EHR" (Sanders 2009)

It seems that progress notes have become a burden to write and a burden to read but are still regarded as being indispensable because they help to communicate the patient’s health information.  That is to say, the usability of the EHR has been one of the big barriers to EHR implementation for quite some time.  It has also been demonstrated in a survey that 90% of doctors are “concerned” or “very concerned” about the usability of EHRs as being a leading obstacle to adoption (Nuance Communications, Inc. 2009).

It was also documented in this survey that physicians cited the following as “important” or “very important”:

• Access to medical records faster without waiting for records to come out of traditional manual transcription (90 percent)
• More complete patient reports, with higher levels of detail on the patient’s condition and visit (83 percent)
• Better caregiver-to-caregiver communication based on improved reporting that is more accessible and easily shared (83 percent)
• Improved documentation by pairing the EHR point-and-click template with physician narrative (79 percent)

What are we doing to help?

·         Observing clinical users to understand their workflows and primary tasks

o   These primary tasks should be up front in the EHR and readily accessible

o   Secondary tasks should be accessed via clear, logical flow

o   Develop information architecture based on users’ workflows

o   Understand context of use (For example, not all applications are suitable for mobile.)

·         Simplify feature set available in the EHR

·         If using a form, improve the experience by attending to workflows and typical behaviors

o   Systems can provide warnings not available on forms

o   System can progressively display information only when/ if needed

·         Support ability to set defaults so that users don’t have to scroll through lists of form/ templates that don’t apply to them

·         Use terms consistent with user group’s vocabulary