The Role of Design in the Design of EMR Systems
By: Kevin Richardson, PhD
The recent Healthcare Information and Management Systems Society
(HIMSS) report, "Defining and Testing EMR Usability: Principles and
Proposed Methods of EMR Usability Evaluation and Rating," (June
2009) provided important insight into the need to consider
usability as a primary driver behind the acceptance, implementation
and success of Electronic Medical Records (EMR) systems in the
United States. The HIMSS report does an excellent job describing
core usability principles and suggests that these principles could
be the foundation for the development of an EMR usability rating
method. The report contends that such a rating system would help
identify useful and important distinctions between competing EMR
systems.
As a usability researcher with a formal background in Cognitive
Psychology and almost 20 years' experience researching, designing
and testing business systems, I agree with the HIMSS authors' call
for prioritizing usability in the development and assessment of EMR
systems. However, their arguments place the needs of users far too
late in the process and do not address the primary issue-the design
of EMR systems. Attempting to address low EMR system adoption rates
by evaluating usability after the system is designed and built is
akin to treating the symptoms rather than the
cause of a disease. Usability, flexibility, task support
and user acceptance are the result of a formalized design process.
It is the lack of a true design process, not the absence of
a usability rating method that will continue to limit adoption of
EMR systems.
All well-designed objects are conceived and built on usability
principles such as simplicity, efficiency and visual presentation.
For my entire career, I have promoted these principles to clients
whether they were working on the simplest website or the most
complex enterprise-level business systems.
Design that focuses solely on features and functionality without
concern for the users, their experiences, goals and contexts will
always lead to increased implementation risks and training costs,
decreased adoption rates and frequent errors.
A rating system informed by usability principles can help
healthcare institutions differentiate between systems that meet
basic requirements and systems that do not. However, considering
usability during the selection process is insufficient to guarantee
a usable system. We must look at how EMR systems are conceived and
developed if we are to ensure that the systems we implement in our
hospitals, clinics and physicians' offices are ultimately both
usable and useful.
A well-designed system is the result of a well-defined
design process. That process includes the
expertise of an interdisciplinary team with individual backgrounds
in graphic design, fine art, architecture, cognitive psychology,
anthropology, humancomputer interaction, and other fields. This
kind of design team has the training and experience to bridge the
gap between business, technology and human requirements. They
practice a design process that is mindful of the features,
functions and legacy systems that must be somehow united,
implemented and maintained. They are equally mindful, though, of
who will be using these systems (doctors, nurses, and pharmacists),
where they will be using them (an emergency room, a suite of
examination rooms), and what they need from technology to improve
rather than impede outcomes.
With this definition of design in mind, it becomes clear that
the current HIMSS usability focus on the evaluation of EMR systems,
while laudable, is ultimately misplaced.
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