NIST to host workshop on EHR Usability June 7, 2011

[image from Passionate: Creating Passionate Users]

Here's a blurb from the NIST website.
It's gratifying to see attention to EHR Usability growing at all levels, and for the emerging tools to put in the hands of users, developers, certification bodies, etc.

A Technical Workshop: Measuring, Evaluating and Improving the Usability of Electronic Health Records
Purpose:
The purpose of the workshop is to establish an open forum for all stakeholders, including Industry, Academia and Government to discuss and provide technical feedback toward development of EHR usability evaluation methods.
The day's events will examine:
  • What facets of usability should be measured?
  • What measurement methods and protocols should be used to do this?
  • What are some of the challenges to rigorous measurement and how can they be addressed?
  • How can measurement results stimulate a market and support improved usability?
The sessions will be a combination of presentations, panels, and highly interactive small group discussions. 
Details:
Start Date: Tuesday, June 7, 2011 
Format: Workshop 
Technical Contact:
Mala Ramaiah
mala.ramaish@nist.gov"

Catch 22: the case for the 13 month year.

I don’t like to work. 

Correction, I do like to work; it’s my opium.

I just don’t like to do avoidable work, particularly, avoidable re-work.

    I have to do that every day. And so do doctors all across the country. Here are some reasons why:
  • Most refill plans cover 90 days with 3 refills or 30 days with 11 refills. Do the math. That comes out to 360 days a year. That is at least 5 or 6 days short by my last count.  Catch 22.
  • Why does that cause a problem? Because insurance companies also refuse to pay for annual visits if it’s not at least 365 days after the last one ("next year"). So a woman who is going to run out of her birth control pills before she can get her annual Pap smear done. 
    • She will run out of medicine before the year is up. 
    • I will get a phone call. 
    • It’s completely predictable and avoidable work.
    • Even worse, people with chronic pain taking opioids (controlled substances)  can only get a 30 day supply, thus they will run out for a whole day in a 31 day month. 

So I am going to make the case for the 13 month year. All prescriptions should be extendable for 13 months. That gives you one month’s worth of grace. Patients get grace. Doctors get a little more peace and quiet to do the REAL work that needs to be done.

While we're at it, make one more programming tweak: The default refill quantities should be 31 days and 93 days.

Teaching with Online Video

Yesterday, one of my family medicine colleagues was bemoaning how long it was taking him to renew prescriptions on his chronically ill outpatients during an office visit. Six minutes! That is untenably long.

I asked him to show me what his experience was. I quickly saw that I could tell him 4 tiny adjustments to make that would cut that time in half or better, and could reduce the number of clicks by two-thirds.

Why didn't this smart man figure out these details? He is not a technophobe.

Why didn't our training do a better job of addressing these details? (Hint: why can't you learn Photoshop in 90 minutes?).

It became obvious that the best way to inform and inspire adult learners was to use narrated video. I can show the hard way. Then I can show the easy way that makes the time savings obvious.

These videos should be 60-90 seconds in length. The example here is a little long. Three minute videos will not be watched by many email readers. Post the length. 

Here's an example:

Does prescribing or renewing medications take you way too long? If so, here's help. Take 2 minutes to watch this video. Impatient? Scroll down and read the bottom line. Watch video (2:16)
In short,
  • Maximize all your window space by moving the left-sided items out of the way.
  • Make the Order Detail window big enough to see all without scrolling.
  • Use the two navigation shortcut buttons to move from one medication entry to the next, and to move to the next incomplete field.
  • Don't collapse or expand window otherwise. That is wasted effort and needless suffering.

This AM, I watched a TED Talk by Salman Kahn titled "Let's use video to reinvent education". It was inspiring. It relates to what I had to say above as well. Watch it below.

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Medications List - Visual Design Make-over

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Attribution

Some rights reserved by CarbonNYC

I'm reading "Designing with the Mind in Mind: Simple Guide to Understanding User Interface Design Rules" by Jeff Johnson. As a typography/layout and design geek, some things are obvious to me, but Jeff Johnson reminds me they are not obvious to everyone. He even makes explicit the cognitive psychology behind the "design rules" that have been gospel to designers.

I'll give his teaching a test drive here, starting with a design from a typical EHR.

Design Make-over - Step by Step

iPhone accessibility feature: Bluetooth Braille reader

Thanks to David Baquis, accessibility Specialist for the US Access Board, who spoke at yesterday's Health IT Usabilty Workshop sponsored by the ONCHIT, NIST, and AHRQ. He opened my eyes to my blind spot for those with disabilities trying to use health IT products.

I found myself wondering if the iPhone had accessibility features. I vaguely recalled that it had Voice Over technology that would read the screen.

I just saw this tweet about a Bluetooth Braille screen reader that works with iPhone. Here's the YouTube video.

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EHR Usability: An Illustrated Guide

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I did a brief presentation at NIST on July13, along with about 2 dozen other usability geeks like me. The government recognizes the importance of having usable software if physicians and hospitals are to be expected to adopt electronic medical records. The ARRA incentives alone won't be sufficient if the software usability is lacking, causing physicians and other healthcare workers to lose productivity. They might break even, but many physicians worry that they won't, even with the financial incentives. Here are the pictures. You have to imagine my voice.

View more presentations from Jeff Belden MD.

NIST will be posting the slides and audio later. You might try here.

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AHRQ publishes paper - "EHR Usability: Vendor Practices & Perspectives"

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AHRQ just published a new white paper last week.
You can read it here as a PDF.

From World Usability Day 2006 poster
The objectives of the project that led to this paper were:

...to understand processes and practices by these vendors with regard to:
  • The existence and use of standards and “best practices” in designing, developing, and deploying products.
  • Testing and evaluating usability throughout the product life cycle.
  • Supporting post-deployment monitoring to ensure patient safety and effective use.
It's good to see continued attention to usability in the EHR/EMR world.