Ron Jimenez, MD, FAAP, one of Stanford Medicine’s medical informatics directors, brought together the concepts of usability, technology, and medicine at the monthly UC Davis Health Informatics Seminar. His goal: make Epic, one of the leading electronic medical record (EMR) system providers, usable for Stanford’s numerous clinics and hospitals.

Why is usability in medical records important?

Think of it this way: doctors manage tens, hundreds, thousands of patients at a time. Some of them still wade through thick “charts” filled with sheets of papers. But that’s horribly inefficient.

Electronic medical records bring the promise of easier access to information and better quality care; not to mention a better quality of life for many physicians. They now have the freedom to work anywhere in a sprawling, large complex that is the hospital.

However, current medical record systems shoot themselves in the foot because they can be very difficult to use — to the point where it can be harmful to patients. Dr. Jimenez argues that good usability is important and can prevent harm. In fact, it’s so important that usability is a national issue:

• Senators want to make sure mistakes are preventable, e.g. Senator Charles Grassley warns of “complications or adverse events that have occurred” as a result of HIT. “Some health care providers have told him that software is producing incorrect medication dosages because it miscalculated body weights by interchanging kilograms and pounds, for example. And, some of those providers have expressed frustration about the response, or lack of, they get when they take those kinds of problems to the vendors or the hospital administration.”
• NIST studies usability factors in EMR’s
• The federal website usability.gov promotes accessibility so that everyone — blind, deaf, hard-of-hearing, and non-disabled — can access content
• AMIA, a professional association, has a task force on usability
• HIMSS, another professional association, has published guidelines such as “Selecting an EHR for Your Practice: Evaluating Usability”

Besides the national attention, Dr. Jiminez touched why nurses and physicians don’t tend to appreciate medical record systems, borrowing terms from the practice of user experience design:

• Lack of a complete feedback loop: for instance, physicians often send prescriptions to a pharmacy (Action) but they don’t receive any confirmation (Feedback)
• As a result, there’s lack of trust in the system. “Do you trust the system to tell you about things or perform what you want if there’s only an 80% success rate?”
• Overwhelming design versus aesthetic and minimalist design. Stanford, he says, is always struggling with decreasing intrusiveness of alerts, widgets, etc. and instead making the interface more helpful.

Epic, he says, has been testing interfaces such as this one for ICU/critical care settings on the iPad, but even then, there are so many details that it can become overwhelming:

He touched on numerous other principles of good usability that practitioners and designers should employ when designing medical IT systems, and applied concepts from Nielsen, Norman, and Tufte. The full broadcast should be posted on UC Davis’s website later on.

There is a lot of work to be done — and opportunity — in this space. Hopefully there will be more demand for usability in medical records as they become ubiquitous through the coming years.