EMR vendors stress usability to attract physicians

Electronic medical record vendors are taking steps to ensure not only that their products have all the bells and whistles required under meaningful use rules, but also that the products are easy for physicians to use.

Though a system's so-called usability has been one of the barriers to physicians adopting EMRs, there have been other pressing issues that vendors, as well as the government, have focused on in an attempt to spur adoption of health information technology.

"It's been a natural progression rather than, 'We forgot about that,' " said Edna Boone, senior director of health care information systems for the Healthcare Information and Management Systems Society, of the recent focus on making systems easier to use.

The EMR market is expected to grow an average of 15% annually, mostly because of the government's meaningful use incentive program, according to a market report by New York-based research firm Kalorama Information. But the marketplace has become quite crowded, and overall usability is the main factor that will keep vendors competitive.

"In the EMR market now, you don't have a clear leader either in total market share or physician loyalty," said Bruce Carlson, publisher of Kalorama Information and author of the report. "Given that, there is an opportunity for somebody to really come out with a much better EMR usability to become kind of the golden standard and come close to capturing the market or being the one that physicians are saying, 'Look, we want to get this system.' "

"How many clicks, how many screen flips, how many keystrokes?" he wrote in the report. "These are the micro-factors that are going to be important in physician adoption of EMR and continued use of the systems."

Vendors are doing several things to make systems easier for physicians:

Reducing click counts and the time it takes to accomplish tasks. Some vendors are trying to streamline how quickly it takes physicians to get something done, realizing that if a task takes longer on an EMR than with paper, it won't be done on an EMR. For example, Carlson cited physician testimony to a Dept. of Health and Human Services committee detailing that it took 10 minutes to order a mammogram on an EMR and two minutes and 15 seconds to enter a family history. On paper, those tasks take only a few seconds. Vendors are realizing that is a waste of physicians' time, Carlson said.

Improving screen-design elements. Font size and colors either can enhance or hinder the user experience. Small type sizes are hard to read, as are certain colors against a particular background. Vendors are making changes that will lead to clearer screen views.

Creating consistencies in screen designs. An inconsistency in the way the layout changes from screen to screen can confuse system users and lead to errors. Sue Reber, marketing director for the Certification Commission for Health Information Technology, which developed a usability rating system as part of its proprietary EMR certification program, said consistency in color coding and the placement of design elements are factors that contribute to a system's intuitiveness.

Reducing information overload. The amount of information on a screen not only can make it difficult for users to navigate through the system but also could result in important information being missed. Vendors are tweaking designs to limit the information on main screens to data that will be needed and used the most.

Reducing alert fatigue. Vendors are trying to create meaningful alerts that are tools for physicians, not annoyances they will learn to ignore. Systems are becoming easier to customize based on the user's needs.

Matching system flow to workflow. For years, vendors and technology experts said installing an EMR required physicians to adjust to what the technology needed to manage the flow of patients through the office. Experts say now more vendors are taking the opposite tack: working with physicians and adjusting their designs so EMRs better fit in with what the practice is already doing.

Building forgiveness into data entry. Systems are being designed to help users correct mistakes easily. Adding features such as a back button that allows users to go back to the previous screen or data field to correct mistakes or omissions easily is another way vendors are making systems more user-friendly.

Efforts are under way to add usability checks to the criteria technology vendors must design their systems to meet to be certified for meaningful use. But because of the competitive nature of the marketplace, vendors aren't waiting for it to become a requirement.

Boone said many are hiring usability experts during the design phase of their systems' development. Many also are going through the Certification Commission for Health Information Technology's proprietary certification program voluntarily in addition to the meaningful use certification. CCHIT's five-star usability rating has been used by several vendors to set their products apart from the competition.

"There's no doubt that good usability of a product is going to be a market [feature] that will drive sales," Boone said.