Bringing Usability to the Frontlines of Medicine

Electronic Health Records and the Challenges for the Usability & Human Factors Community

By Hunter Whitney, November 2007

This article accompanies the November 8, 2007 panel discussion on Health Records Usability.

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 would also be updating the EMR directly, for more timely review by Kelly’s doctor and others who look after her overall health back home in California. 

The Hope and the 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, they 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 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 health care’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 frontline healthcare workers and their patients.

If the goal of EMRs is improving the effectiveness and efficiency of frontline 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.  They 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 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. An intern or a nurse nearing the end of an 18 hour shift may not necessarily have the level of attention and acuity present when she began her rotation. 

Major challenges include:

• Ensuring that health care 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, 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 people have to switch 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 PHRs

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 3rd party advocates and caregivers — spouses, parents, adult children of elderly parents, hospice workers, therapists, and others.