The role of design in EHR systems
` Kevin Richardson received his Ph.D. in Cognitive Psychology in
1991 from the State University of New York at Buffalo. After two years designing interactive training systems for the U.S. Air Force, Kevin spent nearly nine years working at AT&T Bell Labs where he led human factors teams on a large number of projects including IVR systems; web sites and portals; software applications; installation materials; and user experience research. From there, Kevin worked at several large companies where he led usability and design teams for both domestic and international applications and websites.
` Since joining Electronic Ink, Kevin has led projects for such
clients as Penske Truck Leasing, Bloomberg News, EDF Energy, Willis Insurance, and the Premier Healthcare Alliance. Kevin currently serves as Electronic Ink’s Director of Research.
“It took 6 to 8 weeks to become comfortable with our EMR system and a year to get close to my pre-EMR productivity. After 3 years I am no more productive than I was before our EMR.” - anonymous MD `Systems designed around features and functionality are unlikely to be intuitive, creative or flexible.
`“Meaningful Use” addresses features, functions, interoperability, and security – NOT “Design.”
`Problem?
Users are required to conform to system functionality rather than creating systems that support users.
`Solution.
Address the primary issue – the DESIGN of EHR systems. “It took 6 to 8 weeks to become comfortable with our EMR system and a year to get close to my pre-EMR productivity. After 3 years I am no more productive than I was before our EMR.” - anonymous MD `Systems designed around features and functionality are unlikely to be intuitive, creative or flexible.
`“Meaningful Use” addresses features, functions, interoperability, and security – NOT “Design.”
`Problem?
Users are required to conform to system functionality rather than creating systems that support users.
`Solution.
Address the primary issue – the DESIGN of EHR systems.
` Current efforts to address EHR usability are great!
◦ HIMSS report (2009)
◦ TIGER Initiative (2009)
◦ EMR Blogs
xhttp://www.emrandehr.com/
xhttp://www.emrandhipaa.com/
` Shouldn’t designing for and measuring usability guarantee a usable EHR system? Unfortunately not.
` Usability alone does not address questions regarding workflow support, latent requirements or innovative solutions. ` Usability is a prerequisite ⎯necessary but not sufficient. ` Current efforts to address EHR usability are great!
◦HIMSS report (2009) ◦TIGER Initiative (2009) ◦EMR Blogs
x http://www.emrandehr.com/
x http://www.emrandhipaa.com/
` Shouldn’t designing for and measuring usability guarantee a usable EHR system? Unfortunately not.
` Usability alone does not address questions regarding workflow support, latent requirements or innovative solutions. ` Usability is a prerequisite ⎯necessary but not sufficient.
` Well-defined EHR systems are the result of a well-defined and implemented Design Process.
` Designers
◦ Graphic Designers
◦ Artists
◦ Architects ` Expertise
◦ Bridge the gap between business, tech & human requirements.
◦ Mindful of features, functions & legacy systems.
◦ Mindful of who will use the system, where the system will be used, what goals users need to accomplish and how outcomes can be improved.
` Result
◦ Intuitive, innovative, usable and scalable systems. ` Well-defined EHR systems are the result of a well-defined and
implemented Design Process. ` Designers
◦Graphic Designers ◦Artists ◦Architects ` Expertise
◦Bridge the gap between business, tech & human requirements. ◦Mindful of features, functions & legacy systems.
◦Mindful of who will use the system, where the system will be used, what goals users need to accomplish and how outcomes can be improved.
` Result
◦Intuitive, innovative, usable and scalable systems. ◦Cognitive Psychologists ◦Anthropologists ◦Usability Experts
` What It Does
◦ Supports understanding of user tasks, goals and workflows
◦ Coordinates user and business stakeholder requirements
◦ Creates exploratory models of user/system interactions
◦ Conducts iterative concept validation & usability testing ` Design Process Steps
◦ Inform. Begin with a thorough understanding of the user
◦ Discover. Conceptualize models that meet user needs and business goals
◦ Design. Create and test innovative, intuitive, and usable solutions Design process lowers project risk through incremental cycles of evaluation and refinement.
` What It Does
◦Supports understanding of user tasks, goals and workflows ◦Coordinates user and business stakeholder requirements ◦Creates exploratory models of user/system interactions ◦Conducts iterative concept validation & usability testing ` Design Process Steps
◦Inform. Begin with a thorough understanding of the user ◦Discover. Conceptualize models that meet user needs and business
goals
◦Design. Create and test innovative, intuitive, and usable solutions Design process lowers project risk through incremental cycles of evaluation and refinement.
` Understand the user
◦ Who will use the system? The needs of the user community will vary – backgrounds, experience and skill sets.
◦ What tasks will users perform? The system must allow users to work naturally and intuitively.
◦ What is the context of use? System & interface complexity must take user’s work environment into account.
◦ What are users’ prior expectations and experiences? System must acknowledge and incorporate users’ goals and expectations. Information is vital and the quality of this analysis directly affects the outcome of the design process.
` Understand the user
◦Who will use the system? The needs of the user community will vary – backgrounds, experience and skill sets.
◦What tasks will users perform? The system must allow users to work naturally and intuitively.
◦What is the context of use? System & interface complexity must take user’s work environment into account.
◦What are users’ prior expectations and experiences? System must acknowledge and incorporate users’ goals and expectations. Information is vital and the quality of this analysis directly affects the outcome of the design process.
` Conceptualize the EHR system to meet user and business goals.
◦ Researchers discover and validate characteristics that suit user needs and system requirements.
◦ Designers work with users and stakeholders to create concept models of workflows and interfaces.
◦ Researchers and Designers define expectations against which the successful EHR will be measured.
The Discovery process allows for understanding and visualization of requirements, and forms an initial view of the system “landscape.” ` Conceptualize the EHR system to meet user and business goals.
◦Researchers discover and validate characteristics that suit user needs and system requirements.
◦Designers work with users and stakeholders to create concept models of workflows and interfaces.
◦Researchers and Designers define expectations against which the successful EHR will be measured.
The Discovery process allows for understanding and visualization of requirements, and forms an initial view of the system “landscape.”
` Iterative portion of the design process during which all participants (design team, users and stakeholders) influence design decisions. ` Designers use this information to:
◦ Create novel and enduring design prototypes
◦ Expand the existing methods and systems
◦ Explore new solutions that allow users to interact with information in natural and intuitive ways
Prototypes produced quickly during the Design phase enable researchers to test with users - validating concepts and refining models.
` Iterative portion of the design process during which all participants (design team, users and stakeholders) influence design decisions. ` Designers use this information to:
◦Create novel and enduring design prototypes ◦Expand the existing methods and systems
◦Explore new solutions that allow users to interact with information in natural and intuitive ways
Prototypes produced quickly during the Design phase enable researchers to test with users - validating concepts and refining models.
Shouldn’t the goal be to have usability research dictate design?
` Common Perception
◦ EHR developer knows what users need.
◦ Usability testing makes an EHR system easy to use.
◦ Role of design? Designers make it look nice. ` Reality
◦ Design requires trained team of researchers & designers.
◦ Usability is necessary but not sufficient to ensure user adoption.
◦ Good design, by definition, is usable.
◦ Poor design that meets usability guidelines may not be “usable”.
◦ Poor design affects patient interactions and increases risk. Shouldn’t the goal be to have usability research dictate design?
` Common Perception
◦EHR developer knows what users need. ◦Usability testing makes an EHR system easy to use. ◦Role of design? Designers make it look nice. ` Reality
◦Design requires trained team of researchers & designers. ◦Usability is necessary but not sufficient to ensure user adoption. ◦Good design, by definition, is usable.
◦Poor design that meets usability guidelines may not be “usable”. ◦Poor design affects patient interactions and increases risk.
Shouldn’t the goal be to have usability research dictate design? ` What should you expect (and deserve) from good design?
◦ Usable & intuitive
◦ Innovative & inspiring
◦ Beautiful & lasting
◦ Scalable & supportable
◦ More than electronic versions of your current forms! ` How do you ensure good design? Follow a design process.
Shouldn’t the goal be to have usability research dictate design? ` What should you expect (and deserve) from good design?
◦Usable & intuitive ◦Innovative & inspiring ◦Beautiful & lasting ◦Scalable & supportable
◦More than electronic versions of your current forms! ` How do you ensure good design? Follow a design process.
` Traditionally, who designs software for healthcare?
◦ Business analysts
◦ Subject-matter experts ` Business Analysts (BAs)
◦ Business Analysts gather functional requirements for the application from the point of the view of the business. ` Subject-matter experts (SMEs)
◦ Subject-matter experts (even clinical SMEs) act in place of users.
◦ At best, SMEs provide what they believe to be user requirements.
◦ At worst, SMEs provide their own requirements. Be wary of, “Designed by clinicians for clinicians.”
Look for, “Designed by designers with clinicians for clinicians.” ` Traditionally, who designs software for healthcare?
◦Business analysts ◦Subject-matter experts ` Business Analysts (BAs)
◦Business Analysts gather functional requirements for the application from the point of the view of the business. ` Subject-matter experts (SMEs)
◦Subject-matter experts (even clinical SMEs) act in place of users. ◦At best, SMEs provide what they believe to be user requirements. ◦At worst, SMEs provide their own requirements.
Be wary of, “Designed by clinicians for clinicians.”
` Good design doesn’t just happen.
◦ More than a simple checklist of requirements
◦ More than a passing grade on a usability test
◦ More than a set of pleasant - or professional - looking screens ` So what is good design?
◦ Research-based, highly iterative process that focuses on exploring different models of the user-system interaction
◦ Process that delivers a system that is innovative, tested and meets a need
Healthcare providers can influence the form of EHR products.
◦ Require a formalized design process (or implement your own) to collect requirements.
◦ Insist that the EHR flex to fit the user – not the other way around! ` Good design doesn’t just happen.
◦More than a simple checklist of requirements ◦More than a passing grade on a usability test
◦More than a set of pleasant - or professional - looking screens ` So what is good design?
◦Research-based, highly iterative process that focuses on exploring different models of the user-system interaction
◦Process that delivers a system that is innovative, tested and meets a need
Healthcare providers can influence the form of EHR products. ◦Require a formalized design process (or implement your own) to
collect requirements.
◦Insist that the EHR flex to fit the user – not the other way around!
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