When all is said and done and an EMR is installed in a physician practice, success or failure relating to actual use of the product is a function of 'usability'. If the product is not easily usable, either it is only partially utilized simple tasks become a frustration and require far more effort than should logically be required. Apple understands usability. Pick up any Apple product and it just works, logically and simply. The same cannot be said about many EMRs. The majority of effort with respect to EMR development has been devoted to technical functionality and meeting provincial or local requirements. Sometimes the results are not pretty. The products perform the task, but not always with the minimum numbers of steps and also not always in line with the workflow of the provider or administrative user.
Part of the reason for the lack of usability engineering, is the current focus in the market. If EMR products are engineered in order to be able to collect certain data or perform specific tasks in order to qualify for incentive funding, vendors have no choice but to build in the bells and whistles or face not being conformance approved.
I have not seen any incentive funding applied to achieving usability performance targets. Because usability is difficult to measure and evaluate, I can understand why this is the case. In 2009, I interviewed Dr. Clifford Goldsmith, a usability expert on the challenges relating to EMR - Listen to the Podcast
In an effort to address these challenges, the US is tackling usability:
Healthcare IT News reports: The Commerce Department's National Institute for Standards and Technology (NIST) plans to develop standards to help evaluate the ease-of-use of healthcare IT systems. In a notice on a federal contracting Web site, NIST announced it was looking for companies to create a "usability framework" for health IT systems. The job would require "development, refinement and harmonization of HIT usability standards and certification processes. Among the services sought in the contract, NIST wants a firm that can delve into "human factors analysis" and "cognitive task analysis," ways of analyzing how people react to software instructions. NIST also wants its contractors to develop some general theories about health IT design features and to evaluate those theories via "usability" testing. Ultimately, NIST was to create a "well-defined usability evaluation process that includes a roadmap for implementation and indicates where policy decisions are required."
Should we have a similar capability in Canada? How much of a focus should be placed on usability in comparison to technical functionality?
I used to have a usability group as part of my team at xwave. Having worked closely with this group, I learned a lot about usability and the tools/techniques to assess usability. There is definitely a science to assessing and designing usability.
Jacob Neilsen, a noted usability guru, notes that usability plus utility = usefulness. Usefulness is really what we want to achieve and is a balance between utility and usability. People will live with crappy usability (think early word processing software) if the utility is high because what they can do is very useful. Conversely, it doesn't really matter how intuitive an application might be if it doesn't serve a purpose for the person using it.
I find that people focus too much on usability without thinking enough about utility. You see this emphasis frequently in web site design. I've participated in way too many discussion about how a web site looks that totally ignore what the end user might want to do with the site.
I think that any research into the usefulness of EMRs is a great idea. As we shift from the early adopter to the mainstream physician, usefulness will become increasingly important. There are some wonderful resources in many of our universities (such as the HOTLAB at Carleton) that could be tapped to help assess what is needed to make EMRs truly useful.
Posted by: Michael Martineau | February 05, 2010 at 12:49 PM