Designing Useful, Usable and Innovative EHR Systems

developed and honed over generations, the medical profession has created processes, procedures and physical artifacts that serve healthcare professionals and their patients well. yes, there are process improvements to be had. yes, there are inefficiencies inherent in the overlap between healthcare providers and the healthcare industry. however, improving the digital systems that support the medical profession is not the primary problem. usability, while problematic, is not the primary problem either. the problem is the imposition of poorly designed technological solutions to replace the medical profession’s processes, procedures and physical artifacts.

the cost of designing, developing, purchasing and installing electronic health record (ehr) systems, plus the price of “training” health care professionals to change their behaviors in order to adapt to their new electronic systems, amounts to many millions of dollars. in response, medical task forces, healthcare professionals and reporters are sounding the alarm that these new systems are difficult to use, decrease productivity and negatively impact the quality of patient care.

(photo courtesy of workflow.com)	(photo courtesy of emr-ehrs.com)

usability is not the answer

to address these issues, the healthcare industry has focused on the need to identify, employ and measure the usability of these systems. these are laudable and necessary goals but, in the end, they are insufficient. they place the needs of users far too late in the process and do not address the primary issue—poor design. ehr systems informed by usability principles will help ensure that the user-system interaction follows accepted patterns. a rating system informed by usability principles can help healthcare institutions differentiate between systems that meet basic requirements and systems that do not. however, applying usability during the development or selection processes is insufficient to guarantee a useful system once it is deployed.

usable and useful mean very different things. an application or feature can be considered “usable” if users can successfully and quickly complete the task for which it was created. it’s important to keep in mind that usability is, by definition, a post hoc test. usability does not influence the gathering of requirements. it does not define the scope of the system. it does not provide a pathway to innovation.  it is absolutely possible for an application to be usable but not innovative, inspiring, beautiful, lasting or useful.

usability is necessary for good design but it is not sufficient.

attempting to address low adoption rates and dissatisfaction by invoking usability is akin to treating the symptoms of a disease rather than its cause. usefulness, usability, flexibility, task support and user acceptance are the result of a formalized design process. it is the absence of this process, not the absence of an acceptable usability score that limits adoption of ehr and other healthcare systems. we must look at how healthcare systems are designed if we are to ensure that the systems we implement in our hospitals, clinics and physicians’ offices are ultimately both usable and useful .

ehrs can progress beyond ticking features off a checklist. data can be explicitly translated into information and presented to users in ways that support their decisions and actions while freeing resources (attentional and financial) to be spent on problems previously hidden or untouched. disparate systems can be coordinated and aligned. processes and even entire “businesses” can be reformulated to serve user needs as well as user wants.

how? follow a design process.