How to determine an EHR's "usability"

A practical look at information technology issues and usage

By Pamela Lewis Dolancovered health information technology issues and social media topics affecting physicians. Connect with the columnist: @Plewisdolan  —  Posted Aug. 31, 2009.

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When it comes to electronic health records, functionality has had its time in the spotlight. Now, the buzz term is usability.

What's the difference? Functionality is what a system does. Usability is how easily you and your staff can operate the system.

Usability is coming into the spotlight as vendors and consultants are learning that a lack of it has been a major reason many implementations have failed.

The push is now on for practices (and vendors and consultants) to pay less attention to the bells and whistles and more to whether physicians and support staff can figure out how to make them work.

Determining what usability means to you will require a hard look at not only the system but also your practice -- how it works now, how you want it to work, and how ready and able employees are to adapt to technology.

Ron McNamara, PhD, a certified usability analyst who runs the EMR Usability Group, a consulting firm, said that despite the seemingly relative nature of usability, there is some science to it. But at its most basic level, usability means everyone will be able to use the records system to electronically complete tasks in the same or less time as it takes on paper.

McNamara has developed a nine-point assessment that practices can use to help determine a system's usability:

Dictation: A good system will accommodate doctors accustomed to dictating their notes as well as those who are comfortable typing.

Prescriptions: Sending a prescription electronically should be just as fast as writing it on paper.

Ability to receive faxes: Allowing faxes to be imported directly into the EHR should not negatively impact work flow.

Appointment/scheduling integration: With good integration staff will not have to toggle between two systems.

Scanning: Your system should allow documents to be scanned directly into a patient file.

Vital signs: Support staff should be able to enter vitals directly into the patient's file at the time of care, with a touch screen, tablet or laptop in the exam room.

Interface design: Is it customizable to match each physician's current work flow? Can information that is not needed on a regular basis be hidden? Can it be customized according to user (whether physician, nurse, physician assistant)? Is it intuitive and easy enough that a novice can learn to use it?

Office work flow: Is your vendor willing to define current work flow and match the system to it as closely as possible and/or help identify current work flow problems that can be fixed with technology?

Application performance: Does the system take a long time to load? Does it go from screen to screen quickly? Does it crash often? Hardware, as well as software, will be a factor.

Can your staff adapt?

The other important task is assessing your employees' ability to learn a new system.

Jeffrey Linder, MD, MPH, director of the Brigham and Women's Primary Care Practice-Based Research Network in Boston, said there is no test to assess an employee's tech-savviness. So you mostly have to rely on self-reporting.

Allen Wenner, MD, a family physician in Columbia, S.C., said that when he interviews potential employees at his practice, he addresses their tech-savviness with two basic questions.

The first is, "What is your e-mail address?" It must be a personal address, not a current or former work e-mail. The second is, "What operating system do you use?" A response of "Windows" is not adequate. He wants to know what version.

"If a person doesn't know the answer to those things," he said, "then you can't teach the level of technology that is necessary to operate an EMR in a live environment while you are seeing patients." Dr. Wenner is also the co-founder of the High Performance Physician Institute, an EMR training organization.

But that's not to say everyone should be able to program the next best thing to Microsoft Windows. A good EHR system will meet people where they are and allow them to learn as they go along, McNamara said.

Dr. Linder said that during the implementation projects in which he has participated, there was an effort to get diversity on the teams charged with picking a system. The strategy was to form a group with the widest spectrum in terms of age, self-reported tech-savviness and job requirements to test-drive potential systems.

Dr. Linder compared a good EHR to Microsoft Word. He said most anyone can figure out how to use the program, but most users don't use 92% of what's in it. Likewise, a good EHR system will be easy enough for novices to use, but offer more options for a "power user."

The caveat is that if all of the EHR's functionalities aren't being used by the majority of people in the office, the practice is not realizing the system's full potential. That's where incentives come in, Dr. Linder said.

As payment moves from fee-for-service toward pay-for-performance, practices will have the time and motivation to learn and utilize more of the EHR's functionalities, he said. Incentives built around the patient-centered medical home model, for example, will be practicewide, not physician-specific, which means every employee in the practice will have an incentive to learn -- and take their own steps -- to increase the system's usability.

Pamela Lewis Dolan covered health information technology issues and social media topics affecting physicians. Connect with the columnist: @Plewisdolan  — 

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