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Why EHR usability has fallen short

A recent article said that electronic health record (EHR) usability is poor because clinicians are not the ones who are designing the products:

“Physicians and other clinician users of electronic health record systems commonly rate the products low on a usability scale, in large part because non-clinicians do the bulk of the work designing them.”

But does usability really suffer because non-clinicians are designing Health IT solutions? When we look at other industries, we don’t see end users primarily responsible for the design of successful products. For example, accountants don’t design banking technology, and writers aren’t developing word-processing software.

Why do products in other industries seem to be more reflective of users’ needs? For EHR usability to improve, do clinicians have to create and design the products, or is there another more impactful way for them to be involved?

I believe usability lags in Health IT because EHR vendors have not applied rigorous user-centered design (UCD) principles. It’s not that clinicians haven’t been involved, they just haven’t been involved in a meaningful way.

5 design shortcuts that can stunt EHR usability

End users must be involved early and often throughout the design process. Some EHR vendors take short cuts, which leads to poor design that negatively affects usability. These vendors call it user-centered design, but they make these common mistakes:

1) Counting demos as feedback sessions

Let’s say an EHR vendor is presenting a new product concept in front of an audience to collect design input and asks at the end of the session, “Any feedback?” This request for input doesn’t go deep enough to provide meaningful input to the solution.

Fix: Preview the solution in one-on-one sessions with actual users performing relevant tasks.

2) Asking too late

When an EHR vendor only collects user input for a new feature or solution just prior to launch, it’s too late for the clinician to give feedback that can affect product design. The product is about to release, and it would be too costly to change it.

Fix: Involve clinicians earlier in the process with formative testing using sketches, wireframes and prototypes.

3) Giving unrelated tasks

Using testing tasks that do not directly relate to patient safety and the specific end-to-end goals of the user do not adequately evaluate the product. Test results aren’t as valuable.

Fix: Rigorously assess tasks before testing them with users. Involve clinicians in designing the tasks to make sure they are clinically relevant.

4) Listening to (only) the squeaky wheel

EHRs should not be designed by the loudest user.  Don’t overgeneralize one person’s experience or feedback when designing solutions.

Fix: Consider each user’s feedback as a single data point in context with other testing results. Use data to explain to your customers why product direction highlights efficiency, reduction of cognitive load and patient safety, particularly when you make a design decision that is not what they suggested.

5) Testing with the right users

All of these other items assume that the feedback is coming from people who are the actual end users of the solution. Too often, designers only collect feedback from the purchaser, who may not have the same background and goals as your intended users.

Fix: Collect usability data from the people that will be using the product for its intended purpose. It’s okay to collect feedback from others (e.g., purchasing, trainers, IT), too, but let user input guide and have the most influence.

Rigorous UCD processes improve EHR usability. Aligning with best practices is the right thing to do for many reasons, the most important for EHRs is patient safety. It also serves as the most effective and efficient way for clinicians to have an impact on the design of a product.

As Health IT catches up with other industries on the application of UCD, clinicians will be appropriately involved and users of Health IT will feel like the products were designed by someone like them.

To learn more about how Allscripts applies UCD principles, download this white paper.

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