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HIMSS EHR Usability Task Force Report on Defining and Testing EMR Usability

HIMSS EHR Usability Task Force Report on Defining and Testing EMR Usability

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Published by Shahid N. Shah
From the Executive Summary: Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level.
We conducted a literature review of usability principles, especially those applicable to EMRs. The key principles identified were simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context.
Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost-efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results.
From the Executive Summary: Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level.
We conducted a literature review of usability principles, especially those applicable to EMRs. The key principles identified were simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context.
Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost-efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results.

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Published by: Shahid N. Shah on Jul 09, 2009
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02/04/2013

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©
 
2009
 
Healthcare
 
Information
 
and
 
Management
 
Systems
 
Society
 
(HIMSS)
 
 
Defining
 
and
 
Testing
 
EMR
 
Usability:
 
Principles and Proposed Methodsof EMR Usability Evaluation andRating
HIMSS
 
EHR
 
Usability
 
Task
 
Force
 
June
 
2009
 
 
©
 
2009
 
Healthcare
 
Information
 
and
 
Management
 
Systems
 
Society
 
(HIMSS)
 
CONTENTS
 
EXECUTIVE
 
SUMMARY
 
.......................................................................................................................................
 
1
 
INTRODUCTION..................................................................................................................................................
 
2
 
W
HAT
 
IS
 
U
SABILITY
?
 
.......................................................................................................................................................
 
3
 
T
HE
 
C
HALLENGES
 
OF
 
EMR
 
D
ESIGN
 
....................................................................................................................................
 
3
 
S
COPE
 
OF
 
THIS
 
R
EPORT
 
....................................................................................................................................................
 
4
 
USABILITY
 
PRINCIPLES
 
........................................................................................................................................
 
4
 
S
IMPLICITY
 
....................................................................................................................................................................
 
5
 
N
ATURALNESS
 
...............................................................................................................................................................
 
6
 
C
ONSISTENCY
 
................................................................................................................................................................
 
6
 
M
INIMIZING
 
C
OGNITIVE
 
L
OAD
 
..........................................................................................................................................
 
6
 
E
FFICIENT
 
I
NTERACTIONS
 
.................................................................................................................................................
 
7
 
F
ORGIVENESS
 
AND
 
F
EEDBACK
 
...........................................................................................................................................
 
7
 
E
FFECTIVE
 
U
SE
 
OF
 
L
ANGUAGE
 
...........................................................................................................................................
 
7
 
E
FFECTIVE
 
I
NFORMATION
 
P
RESENTATION
 
............................................................................................................................
 
8
 
P
RESERVATION
 
OF
 
C
ONTEXT
 
...........................................................................................................................................
 
10
 
USABILITY
 
EVALUATION
 
AND
 
RATING
 
METHODS
 
...............................................................................................
 
10
 
E
VALUATION
 
M
ETHODS
 
AND
 
M
ETRICS
 
.............................................................................................................................
 
12
 
S
ELECTING
 
T
ASKS
 
FOR
 
E
VALUATION
 
.................................................................................................................................
 
17
 
5
S
TAR
 
U
SABILITY
 
R
ATING
 
S
YSTEM
 
..................................................................................................................................
 
18
 
C
ERTIFICATION
 
AND
 
EMR
 
U
SABILITY
 
R
ATING
 
....................................................................................................................
 
18
 
RECOMMENDATIONS
 
........................................................................................................................................
 
19
 
REFERENCES
 
......................................................................................................................................................
 
20
 
CONTRIBUTORS
 
................................................................................................................................................
 
24
 
A
UTHORS
 
...................................................................................................................................................................
 
24
 
U
SABILITY
 
P
RINCIPLES
 
W
ORK
 
GROUP
 
...............................................................................................................................
 
24
 
E
DITORS
 
.....................................................................................................................................................................
 
25
 
HIMSS
 
EHR
 
U
SABILITY
 
T
ASK
 
FORCE
 
................................................................................................................................
 
25
 
APPENDICES
 
......................................................................................................................................................
 
27
 
A.
 
T
EST
 
TASK
 
AND
 
SCENARIO
 
EXAMPLES
 
.......................................................................................................................
 
27
 
B.
 
B
ENCHMARK
 
EXAMPLES
 
........................................................................................................................................
 
35
 
C.
 
P
ATIENT
 
SAFETY
 
CHECKLIST
 
EXAMPLES
 
.....................................................................................................................
 
36
 
D.
 
U
SABILITY
 
P
RINCIPLES
 
W
ORK
 
GROUP
 
B
IOS
 
...............................................................................................................
 
38
 
 
©
 
2009
 
Healthcare
 
Information
 
and
 
Management
 
Systems
 
Society
 
(HIMSS)
 
E
XECUTIVE
S
UMMARY
 
Electronic
 
medical
 
record
 
(EMR)
 
adoption
 
rates
 
have
 
been
 
slower
 
than
 
expected
 
in
 
the
 
United
 
States,
 
especially
 
in
 
comparison
 
to
 
other
 
industry
 
sectors
 
and
 
other
 
developed
 
countries.
 
A
 
key
 
reason,
 
aside
 
from
 
initial
 
costs
 
and
 
lost
 
productivity
 
during
 
EMR
 
implementation,
 
is
 
lack
 
of 
 
efficiency
 
and
 
usability
 
of 
 
EMRs
 
currently
 
available.
 
Achieving
 
the
 
healthcare
 
reform
 
goals
 
of 
 
broad
 
EMR
 
adoption
 
and
 
“meaningful
 
use”
 
will
 
require
 
that
 
efficiency
 
and
 
usability
 
be
 
effectively
 
addressed
 
at
 
a
 
fundamental
 
level.
 
We
 
conducted
 
a
 
literature
 
review
 
of 
 
usability
 
principles,
 
especially
 
those
 
applicable
 
to
 
EMRs.
 
The
 
key
 
principles
 
identified
 
were
 
simplicity,
 
naturalness,
 
consistency,
 
minimizing
 
cognitive
 
load,
 
efficient
 
interactions,
 
forgiveness
 
and
 
feedback,
 
effective
 
use
 
of 
 
language,
 
effective
 
information
 
presentation,
 
and
 
preservation
 
of 
 
context.
 
Usability
 
is
 
often
 
mistakenly
 
equated
 
with
 
user
 
satisfaction,
 
which
 
is
 
an
 
oversimplification.
 
We
 
describe
 
methods
 
of 
 
usability
 
evaluation,
 
offering
 
several
 
alternative
 
methods
 
for
 
measuring
 
efficiency
 
and
 
effectiveness,
 
including
 
patient
 
safety.
 
We
 
provide
 
samples
 
of 
 
objective,
 
repeatable
 
and
 
cost
efficient
 
test
 
scenarios
 
applicable
 
to
 
evaluating
 
EMR
 
usability
 
as
 
an
 
adjunct
 
to
 
certification,
 
and
 
we
 
discuss
 
rating
 
schema
 
for
 
scoring
 
the
 
results.
 
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