Through decades of working to improve EHR usability, one story stands out for me.
I visited a small doctor’s practice, part of a larger system whose IT vendor had tried to address clinician usability issues for months. The vendor’s leaders had gone onsite in the past, sat in the conference room with the clinicians and listened to their problems and concerns. When they weren’t resolved, my team and I went to observe the clinicians at their day-to-day work.
The doctor, sitting at his computer with the nurse and physician’s assistant, was complaining he couldn’t pull up lab values, and he couldn’t practice medicine without them. I knew from my understanding of the system that he should be able to get his lab values easily. It turned out the doctor’s web browser was so out of date that he couldn’t access the lab values, nor many other features. This was a simple fix made in one day.
Most user experience problems aren’t solved by sitting around a conference table. They’re solved by engaging with the people involved and the work they do.
As the founder of a human factors and user-centered design company, I try to understand how my customers use their systems, what challenges they’re facing and what they need.
What are Human Factors? - Allscripts Podcast, Episode 1
Defining human factors, usability and user experience; responding to US patient safety and usability standards today; how the FDA is an example for raising the bar for EHRs.
When I refer to human factors, usability is a big part of the discussion. Usability refers to the effectiveness, efficiency and satisfaction when a user completes a task in their particular environment with the tools they’re given. This is a small slice within that individual’s user experience. Each of these levels presents opportunities to improve patient safety and clinician experience.
Many healthcare organizations have their own customized health IT solutions configured into EHRs. They have the best access to knowledge about what their clinicians need, the resources and capabilities of their homegrown applications and tools. Working with IT vendors, clinicians and leaders at these organizations can develop a system that accommodates their unique human factors.
Making Systems Work for Humans – Allscripts Podcast, Episode 2
The unique challenges of healthcare technology; how HIT partners can engage with users to discover their true needs; and how the right system supports patient safety and relieves clinician burden.
This can be easier said than done. Focusing on human factors and achieving true user-centered design in an IT system for healthcare is complex in a way it wouldn’t be for other industries. The very different operations of various providers—large hospitals, small hospitals, city hospitals, rural hospitals, ambulatory practices, mental health facilities—make this more complicated.
That’s why it’s key to understand, as a provider or a vendor, that every implementation and the user group it serves is different. While there are patterns of behavior and clinical workflows we can draw upon, we must be aware that every situation differs.
When working with a sound and proven human factors engineering program, you must know the users and what the environment is like where the product is going to be used.
At Every Step, Factor in Humans – Allscripts Podcast, Episode 3
How health IT platforms compare to those in other fields; how hands-on training makes a difference; and how a human-centered approach at every step, from implementation to daily use, creates systems that fit each unique organization.
My advice to address this is pretty simple. Ground yourself and your teams in a sound human factors process, a sound user-design process. As a user yourself or someone who works with users, keep working to raise the standard.
Every time you do an activity or observe a user doing one, evaluate the worth of that activity. Ask if you learned something and how you can translate that into the design, development, and implementation of a system. Again, you can do this as a provider, clinician or vendor, and communicate what you find.
Breaking down these silos in the health IT ecosystem is essential to building user-centered systems.
In the podcast episodes I recorded with Allscripts, we had human factors, user experience, and patient safety expert all talking to each other, sharing good ideas. The same conversation could occur with users and people from a healthcare delivery system, sharing their own ideas and the reality of their experience.
For the doctor at the small practice who couldn’t get his lab values, this conversation would have solved his problem before it began. In that case, we did solve it by taking a real human focus, working together to see what he saw, in the environment he worked in. That’s the approach we all need to continue to take.