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EHR design requires user input, early and often

Adherence to user-centered design (UCD) best practices is key to improving electronic health record (EHR) usability. A recent white paper reviews UCD best practices, and how they help improve usability and patient safety.

Unfortunately, many EHR vendors skip a crucial step in UCD: formative testing. In this phase, software designers test early versions of the technology with actual users. They’re not testing completed code or solutions ready for market, but rather prototypes, wireframes or even early sketches.

Good formative testing is iterative, meaning designers must gather and address feedback from users several times before finalizing the software. To illustrate how the formative testing process works at Allscripts, here’s a recent example from our Allscripts Sunrise™ Ambulatory Care solution.

Example: Formative testing for a new task module

The Sunrise team conducted formative usability tests on a newly designed task module with six clinicians. The User Experience team held one-on-one, remote sessions with each participant lasting 60 minutes each. These sessions helped test a set of 10 specific measurable usability goals, such as “100% of users can view and acknowledge results.”

During each session, the moderator asked the participant to complete a series of tasks on a prototype. For example, one task was to find prescription refill requests for a patient and another was to view tasks assigned to the user.

The moderator observed how well participants were able to complete the task, recording reactions and recommendations for improvement. In this case, participants suggested using a different icon for the workflow manager that was more familiar and intuitive. The moderator then summarized the number of tasks completed and qualitative comments, and calculated a System Usability Score (SUS) from subjective user data.

Results: Users rate interface as more enjoyable and intuitive

Overall feedback on this prototype was positive. All physicians said they would like to use the new functionality, and they felt the workflow was better than the current functionality.

All but one measurable usability goal met or exceeded expectations. On average, users rated the interface 49% more enjoyable, 40% more intuitive, 36% better at giving the right information at the right time, and 70% “newer” and “fresher” looking than the current application. Users also averaged a 97% task completion rate and rated the application as very usable with a System Usability Score (SUS) of 87.

What’s next?

Learning that we didn’t meet one of the usability goals lets us go back and address the issue before the product launches. There are minor adjustments we can make to the Sunrise task module to make it even better. Allscripts will refine the design based on these findings and continue testing with Sunrise users.

The best way to keep users at the center of EHR design is to involve them early and often in the process. Involving them in a meaningful way will continue to improve usability.

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