The other day I was at a conference where several EMR industry insiders presented on user interface issues. I’ll confess, I was expecting the usual defensiveness — “our user interface is just fine, it’s just that our users don’t understand it” — but instead heard a lot of earnest discussion about the problems with today’s EMR UIs. The problem is, none of them seemed have any clearly-defined ideas on how those problems will be addressed.
Speakers at the conference, who included vendor reps, clinicians, academics and more, did seem to agree that few EMRs had achieved satisfactory usability. More than one cited research suggesting that many EMR interfaces just don’t cut it.
If there could be said to be any consensus, it was that usability standards were at best a slippery issue and at worst, might force development in the wrong direction by measuring the wrong thing. One speaker noted that even if clinicians were satisfied with a system’s UI, this might not be the best way to study its value, as it doesn’t mean that the system is particularly efficient.
But that could be a bit of a cop-out. According to a HIMSS paper from 2009, there are several methods which could emerge as front-running approaches to measuring usability and efficiency (which, it seems, are too often addressed separately).
Interestingly, the HIMSS authors said that two completely unrelated safety programs might provide some insight into improving developing EMR usability standards:
* The National Highway Traffic Safety Administration Child Safety Seat Usability Rating Program
According to HIMSS, this program offers several lessons, including that the NHTSA spent two years to develop the program, that it collected data to see how well its ratings were working, and that officials have been flexible enough to change their standards as the market changes.
* FDA and Human Factors Regulation and Guidelines for Device Manufacturers
As some of you may know, the FDA requires device manufacturers to follow Human Factors regs. HIMSS researchers argued that a few aspects of this program can be applied to directly to setting EMR usability standards, including the requirement that the manufacturer be educated in Human Factors, that manufacturers should adhere to standards set by other standards bodies as well as their own, and that manufacturers must be able to prove Human Factors compliance at any stage of the inspection process.
Folks, I don’t know if the anti-standards talk I heard at the conference was just a bunch of posturing, or whether developing usability standards is a great idea, but this is certainly a hot issue. Where do you stand? Can the EMR industry benefit from an externally- or even internally-developed set of usability standards, or are there better ways to spend development time?
What was the conference?
Digitization of electronic medical records has its own advantages. Electronic medical records provide centralization, which has its own advantages at times of emergency.
What is an example of these proposed usability standards? I’m all for standardizing, but of course it’ll cost. With the time and effort put into standardizing EMR usability, would the ‘meaningful use incentives’ be put aside? It’s a way to get money needed for the usability standards, but is there a way to do both simultaneously?
-Danelle
Danelle,
I think that they are trying to do them together. In fact, at one point ONC talked about trying to make EMR Usability part of meaningful use. We’ll see how it plays out.
The FDA has recently release updated draft-format guidance for human factors design for medical devices (http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm259748.htm).
So far I don’t see the connection between ONC, NIST and the FDA. I’d expect them to (hopefully) (eventutally) converge on the topic of usability…
karla
Full disclosure, we have created a HCIT application (clinical operations metrics,*not* EMR) recognized for its UI/UE (user interface.user experience)
This topic is another one ripe for crossed arguments. Standards needed ? Yes. Standards that are ginormously overstated, over detailed, written by PhD theorists to serve the bureaucratic institutions from whence they sprang ? Not so much. Before HCIT, I designed and managed carrier-class network management. Absolutely needed standards, but if they were as hard to use as EMRs are reported to be, lots of people would lose dialtone and that’s not good.
Here’s a “standard” that would help. Never design an interactive information system based on the “databook” approach (using the ultimate list of every piece of data in a subject area and building a place in the database for it, and some spot on the screen for it). Always create pages/screens to reflect an actual user’s task and limit each user’s exposure to those pages, screens and functions that are relevant and necessary for that user. Will those principles alone make a good UI ? No, but it’s a much better start.
I’ve been involved in a few EMR implementations as a “technology consultant” and have had limited training on other EMR systems. The systems I am somewhat familiar with are the major, brand name products and I can’t speak for all vendors. The products I have seen are HORRIBLE and to name a few of the issues without even scratching the surface:
– No consistency between modules or even screens within the same components of the program.
– Terrible color schemes such as green on grey buttons
– Inconsistent or no hot keys
– non content sensitive help screens
– absolutely no thought for consistency between the modules
If these had been commercial products released by an established vendor they would have been laughed off the market as amateurish. After seeing these few products, it is no surprise when I hear there is resistance or confusion. The systems are horrible yet the staff being trained seemed to blame themselves thinking they are “just not computer literate.” I can say with absolute certainty it was not them but the piece of junkware they were trying to wedge into their systems.