When we go about evaluating the Electronic Health Records (EHRs) functionality, standards or certifications, we follow the following usability principles:
- Simplicity: This means information or visual elements that are not necessary to the task are not included in the software package. The functions that are of greater significance should stand out and are easy to understand. The software application should have uncluttered and simple design.
- Naturalness: This implies that the screen metaphors and icons are similar to those other computer application which people or clinicians use. It should also be intuitive such that it is easy learning, and expenditure on training is minimal.
- Consistency: All the parts and terminology of the software has the same look and feel.
- Forgiveness and Feedback: Typically data should be hard to loose, and easy to retrieve. It should also be able to provide feedback on the action the operator is about to take (Help Section).
- Effective language of use: It should use the same terminology as the clinicians. “List or entry-form choices are clear and unambiguous.
- Efficient Interactions: It should minimize the number of steps taken to complete a task. It should provide shortcuts and other methods to minimize the movements for frequent users.
- Effective Information Presentation: The software interface should provide sufficient white space and large enough fonts making it easier for the user. There should also be color-coding and appropriate visual appeal.
- Preservation of context: “The application keeps screen changes and visual interruptions to a minimum during completions of a particular task”.
- Minimize Cognitive Load: This implies that the information required to complete a task is group together for ease of use. The idea is to avoid using multiple screens and to provide meaningful alerts, which are also clear about actions and are appropriately numbered. Also, the application should do all the calculations automatically, such that calculators are not required.
- Technical standards: Among more prominent standards is Health Level Seven International (HL7). It provides “framework for the exchange, integration, sharing, and retrieval of electronic health information”. Software being considered should be complaint with these standards. This will also allow for interoperability with other healthcare system. Similarly, Certification Commission for Health Information Technology (CCHIT®) is a non-profit organization which is mandated to promote use of IT for healthcare purposes. Its programs certify either complete or partial EHR modules. This certification helps the commercial products developer and healthcare providers to meet certain technological requirements. The certification “programs include a rigorous inspection of integrated EHR functionality, interoperability, and security according to criteria independently developed by the CCHIT’s multi-stakeholder, expert work groups using CCHIT’s published testing methods”.
The following key steps will help in identifying topics to be discussed with the vendors before making final decision. This will help greater buy-in from the users and smoother implementation upon selection.
- Engage users from the start.
- Consider practice goals.
- Include usability questions in your Request for Proposal (RFP); solicit responses from multiple vendors.
- Review available survey data.
- Perform usability tests with your final two or three EMR product contenders.
- Observe other similar practices using the products.
- Discuss your findings with the vendors before making a final decision.
Bibliography
CCHIT Certified® 2011. (n.d.). CCHIT Certified® 2011. Retrieved from CCHIT: https://www.cchit.org/cchit-certified
Health Level 7 International. (n.d.). Introduction to HL7 Standards. Retrieved from Health Level 7 International: http://www.hl7.org/implement/standards/index.cfm?ref=nav
HIMSS. (2010, August). Selecting an EMR for Your Practice: Evaluating Usability . Retrieved from HIMSS: http://www.himss.org/files/HIMSSorg/content/files/selecting_emr_eval_usability.pdf
