This article was published in the January 2008 issue (Vol 13, No. 2)

About the Author

Hunter Whitney is principal of The Whitney Media Group, Inc., which offers interaction design, writing, and strategic consulting services for traditional and new media. Specializing in science, medicine, and technology, The Whitney Media Group blends incisive analysis with inventive thinking to create effective and engaging ways to express complex ideas across media. Hunter has dual degrees in English and biology, and has worked as a magazine and newspaper writer, as well as an information and interaction designer.

STC UUX Community Newsletter
Usability Interface

Bringing Usability to the Front Lines of Medicine

By Hunter Whitney for World Usability Day 2007 (Washington, D.C.)

A Scenario

After rolling her vehicle late one rainy Sunday evening, 32-year-old "Kelly", unconscious, is wheeled into an emergency room in Washington, D.C. Her driver's license shows a California address. Given the day, time, and distance from her home, the ER staff has difficulty contacting her physician and getting essential medical history. Every minute spent waiting for this information delays treatment that could save her life or prevent lasting injury.

In Kelly's case, a well-designed and implemented electronic medical record (EMR) could instantly show her medical history, including any adverse drug reaction alerts, so the physician could begin treatment more quickly and confidently. Hospital staff could also update the EMR directly, in order for Kelly's own California-based healthcare providers to review her status and overall health.

The Hope and Expectations

EMRs offer the promise of helping to get crucial and complete medical information into the right hands at the right time. The goal is for EMRs to reduce errors, expedite life-saving treatment at crucial moments, and support communication of issues and treatments between caregivers (both medical staff and personal supporters, such as children of elderly parents), thus maintaining continuity of care. With skyrocketing healthcare costs, EMRs could help to reduce costs and boost efficiency, for example, by reducing redundant medical tests. Health data can also help advance research efforts by collecting aggregate outcomes data for major diseases.

The people who work in the medical industry and those directing government health policies know the EMR is a fundamental part of healthcare's future. The benefits of standardizing EMRs, however, come with a wide range of complex human challenges. As is so often the case, more is not always better. Opening the floodgates to a torrent of electronic medical information-without careful design consideration-could increase stress and create inefficiencies and risks for front line healthcare workers and their patients.

If the goal of EMRs is to improve the effectiveness and efficiency of front line healthcare, how can we ensure the system will perform well at the human level? Usability and human factors professionals have a unique role and responsibility to help bring user-centered design principles into this dialog now.

The Human Challenges

EMR systems will be used by a wide range of healthcare workers, including physicians, nurses, pharmacists, administrators, and others involved in a patient's treatment. Healthcare workers have different knowledge, experience, and terminology, while at the same time they share a common need to make important decisions correctly, often under pressure.

The environment, and the very nature of the work, dictate the need for EMRs to make vital patient information findable and usable quickly, even in the face of caregiver stress and fatigue. Interns or nurses nearing the end of an 18-hour shift may not necessarily have the level of attention and acuity present when they began their rotations.

Major challenges include:

• Ensuring that healthcare providers know that relevant information is available, without having to hunt for it.
• Avoiding a negative impact on provider workflows or the time spent per visit.
• Ensuring effective use and information comprehension among different users.
• Identifying who needs what information for effective decision-making and quality of care.
• Designing interfaces for a range of devices with different input modes and displays.
• Reducing the potential for confusion and ambiguity by clear, careful, and consistent use of medical language.
• Making data capture fit the context of use, in such environments as clinics, hospital bedside, operating theatre, roadside trauma response, not to mention the home.
• Creating "contextually aware"; and dynamic systems that can display the needed information in a way it is most relevant to specific users for the given circumstances.
• Easing cognitive load when switching from one system/interface to another, which may arise in a scenario where EMRs provided by different vendors all have to be accessed by one physician or pharmacist.
• Protecting patient privacy while ensuring relevant information availability, and effectively communicating privacy decisions and constraints at the interface level (e.g., permissions input, disclosure information).

EMRs' Being Extended to Personal Health Records

Along with the EMR is the related, but distinct, concept of a Personal Health Record (PHR) that can help patients take more control over their own health-related information. However, it puts the quality, data recording, and information management responsibilities partly on the shoulders of the patient. It also brings in a new user population among third-party advocates and caregivers, spouses, parents, adult children of elderly parents, hospice workers, therapists, and others.

The Questions for Usability

Usability and human factors professionals will need to draw upon their full range of skills and practices to help advocate and create effective EMRs and PHRs. What kinds of questions do we need to ask ourselves in the healthcare domain?

• How can a reliable and quality-focused user experience be created in a multi-user, multi-interface, fragmented system?
• Who will be the decision makers for implementing a usable EMR experience? How might usability effort and findings be coordinated and pooled for the maximum benefit and to reduce re-inventing the wheel?
• How do we articulate the value and the role of usability to gain commitment from the vast number of decision makers and stakeholders who are and will be involved in these efforts?
• How do our methods need to be adapted to address user needs analysis and testing in the complex environments of patient care?
• How can we raise awareness of the importance of usability/human factors in the medical field?
• How much do usability/human factors professionals need to learn about medicine in order to work effectively in this environment?