User Experience is Hot HIT Topic with Good Reason

User experience in the world of healthcare IT has never been a hotter topic. It seems not a day goes by that I don’t come across an article, blog, tweet, or outright rant regarding the state of user friendliness, especially with regard to EMRs. (Who can forget the American Medical Association’s note earlier this year to Farzad Mostashari, peppered with complaints about physician usability of EMRs?) I see plenty of negative coverage around the topic – plenty of folks like to have a soapbox to stand on, after all.

I don’t, however, see enough coverage devoted to businesses and providers working to make the backlash better. Surely there are unsung heroes out there in the world of HIT UX that are at their drawing boards right now, attempting to take the sting out of those extra clicks, and listening with bated breath to providers’ complaints and praises.

I came across one such story in New Orleans a few months ago, where, like many of you, I tried to successfully drink from the fire hose (bottled water, actually) that was HIMSS13. I was able to sate my thirst for good UX news at the PointClear Innovation Awards breakfast, which honored a select group of the company’s clients for their work in the realm of user experience.

McKesson took home top honors this year, and while I had some knowledge of their work in the area, I didn’t realize how great of an emphasis they have placed on making sure their healthcare IT solutions are used in the most optimal way for the best possible patient outcomes.

“The big dynamic we are trying to tackle is around critical decision makers,” explains Bobby Middleton, Executive Director, Enterprise Intelligence Product Management at McKesson. “Through experience with our customers and continued research, it is becoming very obvious that our healthcare leaders are often put in a position to make critical decisions without pertinent, relevant and timely information.

“Our Enterprise Intelligence solutions are all geared around providing the right information to the right person at the right time,” he adds. “Our User Experience research is being used to make sure the targeted offering we are delivering via these solutions help a specific set of critical decision makers make the right decision. It is going great so far, and really allowing our technology teams to connect with their end consumers.”

I wonder if we’ll start to see more positive publicity of efforts like McKesson’s, especially as Stage 2 draws closer, more and more providers consider switching to more mature EMRs, and next year’s predicted influx of the newly insured start to clamor for greater digital engagement options and price transparency. One less click or toggle may just make all the difference when it comes to quality patient care.

About the author

Jennifer Dennard

Jennifer Dennard

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

5 Comments

  • There is no doubt that there is an increase and welcome emphasis on usability. However, for users to make use of this change they have to be able to find specific product information. That’s not a simple thing. There are many UX sites and many EHR sites, but almost none cover this issue exclusively

    Currently, users can find many articles, etc., on EHR usability standards and tests, but I can’t find a single site that has run UX tests against a field of products, much less publish the results. Last fall the Institute of Medicine took on the problem of developing significant information on using EHRs. http://goo.gl/VUAIz

    In part, the IOM stated: “The goal of collecting and publicly reporting user experiences is to improve products across the industry and promote safety. After a decade of development and experience, EHRs and other health IT products have not advanced sufficiently; nor have they been adopted widely and enthusiastically, in step with other consumer products such as smartphones and iPads. Some have referred to this as a market failure (Mandl and Kohane, 2012). With EHRs, unlike other consumer product areas, there has been little opportunity for cross-vendor comparison, which has stifled the evolution of this technology.”

    To that end at the EHRSelector.com, we’ve added these usability features to our product profile for vendors:
    1. Product’s usability has been designed or is being redesigned in accord with NIST (National Institute of Standards and Technology) Protocol 7804, Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records.
    2. Results of compliance with NIST (National Institute of Standards and Technology) Protocol 7801 are available.
    3. Product’s usability standards are documented and available. (0)
    4. Product’s compliance with vendor’s usability standards is available. (0)
    5. Vendor maintains lists, database, etc., of product’s known usability problems and planned remediations. (0)

    We don’t pretend that this covers the many issues that vendors should answer on usability, but they are a beginning.

  • I find your accolades for McKesson laughable and extremely ironic considering my own personal experience with them and their “VARs” I can only describe McKesson as opportunists and extortionists. Having wasted almost years in a doomed attempt to implement McKesson’s antiquated and worthless EMR product, Medisoft Clinical, I can confidently say this, “Avoid McKesson and any EMR/EHR product marketed & sold via third parties (VARs or consultants)!”
    Skeptical? Consider the following: While anyone with any inkling of honesty will have to admit that the only reason for being in business is to make money, McKesson and it’s VARs have refined that monetary extraction process, as well as avoiding any responsibility to an art form. First, they sell you an antiquated product that they know can’t work or meet your needs. Also, they subtly and slyly reveal after the sale that portions of the purchased product really aren’t ready for delivery or usage, so they don’t even give you that software. “Maybe they’ll get to at later.” Second, they delay and drag their feet for months on the implementation, getting upset when we call to inquire or request progress or status reports. Then they claim that the implementation period has expired, despite the fact that the implementation is not even close to complete and the product is not even close to usable. They then claim that they need more money and a new support contract to continue the unfinished implementation.
    Severing the ties with the first VAR & paying another VAR for the support contract really doesn’t improve matters. The new VAR doesn’t do anything to keep customers apprised of updates or patches. Nor will they do anything to help complete the still incomplete implementation, unless more money is paid to them.
    Then we get to the core product itself… Medisoft Clinical is an antiquated code base that so restrictive and cumbersome that it simply can not fulfill the needs of a modern practice or clinic. For instance, when we finally got to the point that we could consider using it for billing encounters (office visits) we discovered that the program would allow no more than 4 diagnosis codes per encounter claim. This limitation was (or should have been) known to the VAR at the time of purchase. A casual perusal of our SuperBill and/or a single question during the preliminary conversations about our practice workflow and billing procedures would have identified this glaring problem. The fact that never during the conversations about our workflow and billing practices did the VAR mention this program limitation, despite being provided with numerous copies of actual encounter SuperBills that revealed the obvious practice billing needs, indicates nothing short of willfull, intentional omission and avoidance of this issue. Furthermore, we actually asked the VAR on several occasions when we would be able to begin using the EMR software for billing, only to be put off by the VAR with statement that we “were not even close to that point, yet.”

    I could go on, but I am getting too tired and frustrated.

    Suffice it to say that Meaningful use reporting for the McKesson Medisoft Clinical (Practice Partner) product was just a horrible after thought. A report generator is provided, but it provides only a sheet of paper with numbers on it. There is no way to research the validity of the reported numbers. So, good luck if any of your measure values are low and you wish to search for answers in the software. Also, the order and wording of the measures on the generated report don’t even correspond to the CMS measures. Furthermore, requests for assistance in researching measure reported numbers only falls on deaf ears. And don’t think for a minute that you’ll ever see a more useful MU tool for Medisoft Clinical (Practice Partner). Nor is any VAR likely ever to risk their relationship with their cash cow (McKesson) by relaying to McKesson the concerns or issues faced by the customers.

    So, tell me again how great McKesson is…

  • Robert,
    Thanks for sharing your experience with McKesson. We need more doctors talking about their experiences with EHR so that EHR vendors can be held accountable and can improve their products. If doctors don’t make their voices heard, then it won’t get better. Considering EHR is going to be part of the future of healthcare, we need them to improve as much as possible.

  • I am excited that Usability is FINALLY getting some attention in the healthcare field.

    Most enterprise software had always been designed with an “engineering-centered” design philosophy and it never worked well for most end-users. Remember the HP calculators of the 1970s (see http://www.hpmuseum.org/ ) ? They were great for mathematicians, but the general public was confused. These calculators were very much analogous to the focus on “expert users” in large enterprise and HIT systems.

    Healthcare IT has been very slow to catch up with the Enterprise software world. It would be nice is HIT doesn’t make the same mistakes that was made so many times before. (If you don know the past you dont know the future!)

    The answer is User-Centered design. A design philosophy that creates a culture of understanding and enabling end users to perform “their” tasks using an information architecture and taxonomy that matches “their” mental model.

    I’m thrilled that the meaningful use stage 2 funding will require a report of summative usability testings (using the NIST CCIF template). I’m scared that this report will become similar to the “VPAT” for Section 508 compliance, As long as you have VPAT report you are in compliance–irrespective of the number of violations of the principles of accessibility and universal design.

    Bennett Lauber
    VP User Experience
    TheUsabilityPeople.com
    HealthCareUsability.com

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