Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating

For more information about the Information Experience Laboratory, visit http://ielab.missouri.edu/Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level. We conducted a literature review of usability principles, especially those applicable to EMRs. The key principles identified were simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context. Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost‐efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results. (42 pages

Elements of EHR Usability: Visual Design

For more information about the Information Experience Laboratory, visit http://ielab.missouri.edu/This presentation discusses visual design and usability. Topics include bullet graphs and use of color. (55 slides

Agile Management of a Mobile Application Development Project for Surgeon Workflows

This case describes the agile management methods for an iPhone software development project. The overall objective was to design a smartphone solution that allowed surgeons access to dynamic Electronic Health Record (EHR) data to optimize their workflow. Three separate organizations distributed the responsibilities. Specifically, the lead organization, Cerner Corporation, collaborated with the University of Missouri Health Care and University of Missouri Information Experience Lab to create the technology. Project goals included increased surgeon satisfaction; improved task efficiency, as measured by time spent retrieving lab and vital sign data on morning rounds; dynamic data accessibility; and increased revenue from new product sales. To accomplish these goals, agile project management was utilized, applying iterative usability methods to create deliverables within a short development cycle. Each development cycle focused on user-centered design principles. Several challenges were encountered related to the user-centered design methods, usability data extraction, academic collaborations, and interface design choices

Home blood pressure data visualization for the management of hypertension: using human factors and design principles

Abstract Background Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, we face an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. We designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension. Methods We used an iterative, rapid-prototyping, user-centred design approach to determine the most appropriate designs for this data display. We relied on visual cognition and human factors principles when designing our display. Feedback was provided by expert members of our multidisciplinary research team and through a series of end-user focus groups, comprised of either hypertensive patients or their healthcare providers required from eight academic, community-based practices in the Midwest of the United States. Results A total of 40 participants were recruited to participate in patient (N = 16) and provider (N = 24) focus groups. We describe the conceptualization and development of data display for shared decision making around hypertension. We designed and received feedback from both patients and healthcare providers on a number of design elements that were reported to be helpful in understanding blood pressure measurements. Conclusions We developed a data display for substantial amounts of blood pressure measurements that is both simple to understand for patients, but powerful enough to inform clinical decision making. The display used a line graph format for ease of understanding, a LOWESS function for smoothing data to reduce the weight users placed on outlier measurements, colored goal range bands to allow users to quickly determine if measurements were in range, a medication timeline to help link recorded blood pressure measurements with the medications a patient was taking. A data display such as this, specifically designed to encourage shared decision making between hypertensive patients and their healthcare providers, could help us overcome the clinical inertia that often results in a lack of treatment intensification, leading to better care for the 35 million Americans with uncontrolled hypertension

Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs

Abstract Background Nearly half of US adults with diagnosed hypertension have uncontrolled blood pressure. Clinical inertia may contribute, including patient-physician uncertainty about how variability in blood pressures impacts overall control. Better information display may support clinician-patient hypertension decision making through reduced cognitive load and improved situational awareness. Methods A multidisciplinary team employed iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. An attitude and behavior survey and 10 focus groups with patients (N = 16) and physicians (N = 24) guided iterative design and confirmation phases. Thematic analysis of qualitative data yielded insights into patient and physician needs for hypertension management. Results Most patients indicated measuring home blood pressure, only half share data with physicians. When receiving home blood pressure data, 88% of physicians indicated entering gestalt averages as text into clinical notes. Qualitative findings suggest that including a data visualization that included home blood pressures brought this valued data into physician workflow and decision-making processes. Data visualization helps both patients and physicians to have a fuller understanding of the blood pressure ‘story’ and ultimately promotes the activated engaged patient and prepared proactive physician central to the Chronic Care Model. Both patients and physicians expressed concerns about workflow for entering and using home blood pressure data for clinical care. Conclusions Our user-centered design process with physicians and patients produced a well-received blood pressure visualization prototype that includes home blood pressures and addresses patient-physician information needs. Next steps include evaluating a recent EHR visualization implementation, designing annotation functions aligned with users’ needs, and addressing additional stakeholders’ needs (nurses, care managers, caregivers). This significant innovation has potential to improve quality of care for hypertension through better patient-physician understanding of control and goals. It also has the potential to enable remote monitoring of patient blood pressure, a newly reimbursed activity, and is a strong addition to telehealth efforts

Patient and physician information needs for display of blood pressure data to support shared decision-making

"Eighty million US adults have diagnosed hypertension, and nearly half of those are uncontrolled. Clinical inertia in getting blood pressure (BP) to goal is partially due to uncertainty about the patient's true BP. An easy-to-read display of clinic and home BP viewed simultaneously by physician and patient might clarify the problem and aid in shared decision making. "--Background

Using patients' life events to put blood pressure data in perspective

"The advent of home Blood Pressure (BP) monitors is expected to generate huge amounts of data likely to overwhelm healthcare providers. This data is believed to contain important medical information which can help physicians provide effective and personalized treatments to patients diagnosed with hypertension. However, interpretation of this data presents a unique set of challenges, such as measurement context and volume. Currently we are working on designing an integrated BP display that presents home BP data together with medication and office BP values to allow for an effective interpretation by the physicians and patients during the visit encounter. To address the measurement context problem, we propose to couple this numerical data with patients' 'life events'."--Context