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Comp 15 - Usability and Human Factors

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  1. Comp 15 - Usability and Human Factors Unit 6a - Electronic Health Records and Usability This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.

  2. Why? Health IT Workforce Curriculum Version 2.0/Spring 2011

  3. Why? (cont.) Health IT Workforce Curriculum Version 2.0/Spring 2011

  4. What Is It? Health IT Workforce Curriculum Version 2.0/Spring 2011

  5. The State of the Art Health IT Workforce Curriculum Version 2.0/Spring 2011

  6. State of the Art (cont.) Health IT Workforce Curriculum Version 2.0/Spring 2011

  7. But…. Users involved in EHR design/review Vendors compete on usability [is this something that should be competed on? Not a basic requirement?] Users demand better products Plans for formal usability testing increasing Vendors willing to collaborate AHRQ:Report on Vendor Practices Health IT Workforce Curriculum Version 2.0/Spring 2011

  8. State of the Arguments Health IT Workforce Curriculum Version 2.0/Spring 2011

  9. AHRQ:Report on Vendor Practices Health IT Workforce Curriculum Version 2.0/Spring 2011

  10. The Bad and the Ugly • Examples of egregious usability problems • (Silverstein, 2009) • Related data far apart, requires user to click multiple times (‘clickorrhea’) • e.g. diastolic blood pressure 4 screens from systolic • Diagnosis (Dx) lists with rare Dx at top, common at bottom, hidden terms • incorrect selection Health IT Workforce Curriculum Version 2.0/Spring 2011

  11. What is Wrong With This Picture? Health IT Workforce Curriculum Version 2.0/Spring 2011 11

  12. What is Wrong With This Picture? (cont.) Note the warning that there are no warnings about abnormal results "There are no indicator flags” Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  13. What is Wrong With This Picture? (cont.) Results section says "negative" and "results final” Most busy clinicians' eyes would stop there, especially in the wee hours Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  14. What is Wrong With This Picture? (cont.) Addendum to the report that the result is actually positive for MRSA, a drug-resistant infection No flag on that addition, yet during data entry at the lab, a flag was requested and seen by the reporting technician Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  15. What’s wrong Health IT Workforce Curriculum Version 2.0/Spring 2011

  16. More of the Bad • Alphabetical problem list • Convenient for programmer, not for the doctor • Should prioritize by importance Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  17. More of the Bad (cont.) • List auto-populated by system • Not editable by clinician • Patient does not have atrial fibrillation (entered by nurse to speed order) • Requires vendor to remove Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  18. More of the Bad (cont.) • Multiple diabetes entries (incorrect) • Lack of controlled terminology mapping • Useless information: • ‘Medication use, long term’ • Clutters screen Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  19. More of the Bad (cont.) Repetition, extraneous information, lack of focus and clarity Lack of any symbolic or diagrammatic representations, and general clutter Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  20. More of the Bad (cont.) Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  21. More of the Bad (cont.) Forces user to keep track of columns with finger on screen Easy to confuse columns Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011

  22. What is Wrong Here? Units (e.g. mg/dL) in every line, repetitious, distracting Lab panel components scattered Courtesy Dr. Scot Silverstein, http://www.tinyurl.com/hostileuserexper Health IT Workforce Curriculum Version 2.0/Spring 2011