Heads-up on EMR usability discussion

On April 21 I’ve been invited to testify again on behalf of patients at a meeting organized by the Office of the National Coordinator for health IT.  As we did here twice last year, let’s discuss what the meeting should here.

Here’s the document they sent.  Comments, please!

Certification/Adoption Workgroup
April 21, 2011
9:00 a.m. to 5:30 p.m./Eastern Time
Renaissance Washington Dupont Circle Hotel
1143 New Hampshire Avenue, NW, Washington, DC

Instructions and Questions for Panelists


Testimony from this hearing will help the Adoption/Certification Workgroup formulate recommendations to the HIT Policy Committee and the National Coordinator on usability of EHRs.  If you have any questions, please contact Marc Probst or Larry Wolf, Chair and Member of the Workgroup:  marc.probst@imail.org or larry.wofl@kindredhealthcare.com

Format of Presentation:

The Workgroup respectfully requests that panelists limit their prepared remarks to five (5) minutes.  This will allow the Workgroup to ask questions of the panelists and allow every presenter time to present his or her remarks.  We have found that this creates a conversation for a full understanding of the issue. You may submit as much detailed written testimony as you would like, and the Workgroup members will have reviewed this material in detail before the hearing.  PowerPoints will not be needed.

Pre-Presentation Questions/Themes:

The questions below represent areas the Workgroup intends to explore at the hearing.  Please feel free to use them in preparing your oral and written testimony; the Workgroup recognizes that certain questions may not apply to all presenters.

The Workgroup respectfully requests panelists to provide written testimony no later than April 15, 2011. Please submit the testimony to Judy Sparrow at Judy.sparrow@hhs.gov


Panel 1: Care Provider Perspective

  • How do clinicians generally view usability? For disabled physicians, what are their specific needs/issues in using EHR systems?
  • What aspects of use/workflow/device interaction/data presentation are the most important regarding clinicians’ EHR systems?
  • How do providers define what are mission critical usability issues, and what are ease-of-use usability issues?

Panel 2: Consumer Perspective <== This is where our input is requested

  • To what extent has usability of EHRs helped in providing patients access to their health information and engaging patients in their care? Particularly in:
    • Getting an electronic copy of their health information upon request
    • Getting an electronic copy of discharge instructions
    • Getting a clinical summary
    • Getting electronic access to their health information
    • Being provided educational resources specific to their care  needs
  • To what extent is usability of health information technology, by care providers, an issue for health care consumers? Has it supported better interactions with the care providers?
  • Do consumers believe that health IT is safe? How does usability factor into that perception?
  • What aspects of health IT usability would consumers like to see improved?

Panel 3: Technology Developer Perspective

  • What is current industry practice in testing for usability?
  • What is current industry perspective for designing systems to ensure usability?
  • What are the biggest usability challenges being experienced?
  • What voluntary steps can industry take to improve usability? What does the industry see as the government’s role?

Panel 4: Measuring & Improving Usability

  • What is the state of art of measuring usability? What can and cannot be measured?
  • What are the areas of usability measurement which we know enough to be helpful to industry?
  • What areas of usability measurement are still theoretical and not ready to be applied in a commercial setting?
  • Can usability be measured in a way that does not stifle innovation?

Panel 5: Options for Creating a Market around Usability

  • Can transparent reporting improve usability? Will this promote or hamper innovation?
  • What other actions/programs can improve usability?
  • How can the end user better appreciate the challenge of usability at the time of purchase?
  • What voluntary steps can industry take to create a market around usability?
  • What uniform information can be provided across all vendor products?

Posted in: medical records | policy issues




3 Responses to “Heads-up on EMR usability discussion”

  1. Hi Dave,
    Thanks as always for sharing and listening! Glad to see you will be on this panel! Also appreciate that ONC is addressing the HIT usability issue–as it is critical. Along with championing consumer use of their own data–in a usable format, my thoughts are we also need to match a consistent “process” for consumer use of usable HIT.

    Having had just experienced this on a personal level–patients/consumers often are given conflicting information in person vs. what is available via their own data access (print or electronic)–which only muddies the already murky water.

    I use the process of “scripting” (same questions consistently asked to assure good service) as an example:

    (Harris Teeter as a model-paraphrased at the mercy of my memory)
    1. “Did you find everything you were looking for?”
    2. “Do you have your VIC card?”
    3. “Do you have any coupons?
    4. “Paper or Plastic”
    5. “Do you need any help to your car?”

    Translated for Health Care (Questions should be used in any setting)

    1. “We saw you today because….” (data consistent with what will be provided to patient.)
    2. “The results were…” (data consistent with what will be provided to patient.)
    3. “Short term (next day, week or month), your goal (a shared decision based upon accurate information and informed input from the patient)”….(consistent with what is provided to the patient.)
    4. “Long term (years’, assuming a healthy life is desired), your risks and potential are….”
    5. “Your next follow-up is….”
    6. “What questions do you have?”

    Some may think this creates a robotic like interaction, yet research has proven that it most often allows for multiple opportunities for the consumer/customer to ask questions, prevents omission of critical information and provides the expectation that the experience should be a positive one. My point is that there are two issues which cannot be separated: HIT usability (the patient has to be able to access, utilize and interpret their data) and the in-person experience (these recommendations cannot be in conflict with the data provided.) Both the in-person and HIT experience must be process based, and organized in a fashion that provides clear information so consumers can make decisions in concert with their providers. Both HIT and “human” usability need some tweaking.

  2. Dear Dave and Lindsey,

    Nothing wrong with a solid check-list! It saves life at the OR and it enhances the quality of the communication. Because that’s what it’s all about. Providing information without communication isn’t going to do the trick in HIT.
    Your checklist made me think of the RICE rating scale my colleague Hay Derkx developed to assess the quality of telephone communication. See http://www.medicinfo.info/%7Ba7cea2f9-446c-4816-93dc-0621e04e736a%7D for the details. We may just need such a checklist to assess the quality and effectiveness of HIT information and communication.

    Best of luck!

    Bart Brandenburg, MD, medicinfo, The Netherlands

  3. From personal experience, this is the way an EHR Should work: http://bit.ly/ezrgae

    Also, you should comment on making consumers more aware of benefits of HITECH/MU, See: It’s your data ask for it http://bit.ly/ebvb3o

    If more patients knew to ask, usability would be driven into more products by providers that need to use patient engaging features.

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