Certification/Adoption WorkgroupEHR Usability Hearing – April 21, 2011

Report to the HIT Policy Committee

May 11, 2011

Marc Probst, Co-ChairLarry Wolf, Member

EHR Usability Hearing

• Purpose of hearing– Real-life experience with EHR’s– Current state of usability testing– Potential future directions

• Panels– Care Providers– Consumers– Technology Developers– Measuring and Improving Usability– Market Feedback and New Technologies

• FACA Blog– Public Comments

Farzad Mostashari, National Coordinator – Opening Comments

• Improve transparency on usability• Technology that fully supports care• Identify and address potential safety issues• Enable constructive innovation• Flexible and rigorous options for usability evaluation

Panel 1: Care Providers - Panelists

• Moderator: Joseph Heyman • Christine A. Sinsky, MD• Stanley F. Wainapel, MD, Montefiore Medical Center • Chantal Worzala, American Hospital Association• Nancy Staggers, PhD, RN, University of Maryland • Abel Kho, MD, Northwestern University

Panel 1: Care Providers - Highlights

• Time is precious• Cognitive load including disabilities• Collaborative Care• Complexity

– Feedback loops– Multi-vendor / multi-systems– Switching cost– Care complexities

• Not just about the user interface

Panel 2: Consumers - Panelists

• Moderator: Larry Wolf • Beth Morrow, Director of HIT, Children’s Partnership • Dave deBronkart, e-patient Dave• Jennifer Simpson, American Association for People With

Disabilities • Eva Powell, National Partnership for Women and

Families

Panel 2: Consumers - Highlights

• Meet the information needs of the consumer• Collaborative care – role of the consumer• Privacy and security• Consumer expectations on the rise• Use caution when repurposing data

(Coding for care is different from coding for billing)

Panel 3: Technology Developers - Panelists

• Moderator: Marc Probst • Carl Dvorak, EPIC • Jacob Reider, Allscripts • Mary Kate Foley, VP User Experience &

Lauren Zack, Director Usability, AthenaHealth • Maureen Ladouceur, VP, Clinical Solutions, Vocollect

Health Care• Bill Hashmat, CIO, CureMD

Panel 3: Technology Developers - Highlights

• Usability is important • Assessing usability is part of development• Local customization/Implementation• Assess usability in context after implementation• Regulation – spectrum of views

Panel 4: Measuring & Improving Usability - Panelists

• Moderator: Charles Kennedy • Dr. Jiajie Zhang, University of Texas Houston• Lana Lowry, NIST • Ben Shneiderman, University of Maryland • Ross Koppel, University of Pennsylvania • Bakul Patel, Food and Drug Administration

Panel 4: Measuring & Improving Usability - Highlights

• Science of usability testing• An abstract framework for assessing usability –

process + technical evaluation

Panel 5: Options around Usability - Panelists

• Moderator: Charles Friedman, ONC • Karen Bell, CCHIT • Mike Smith, General Manager, Financial & Services

Research, KLAS • Doug Solomon, IDEO • David Kreda, Harvard/Boston Children’s

Panel 5: Options around Usability - Highlights

• Current testing and feedback – CCHIT & KLAS– Coarse grained model– Public reporting

• One size cannot possibly not fit all• Importance of design• Experimental design options

FACA Blog

• 34 comments• Consistent with the testimony at the hearing

Overall Summary

• Usability is in the eyes of the beholder• Combination of many factors• Heard a variety of frustrations• Need to access data that’s meaningful• Differences between panels on what can be measured• Need to share best practices• Usability is a community journey

Next Steps

• Develop written letter to ONC• Workgroup meeting: May 2011• Letter to ONC: June 2011 Policy Committee Meeting

• NIST Workshop: June 7, 2011

Appendix

NIST EHR Usability Protocol

• NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records – NISTIR 7741 – November 2010

• Appendix A: Guide to Completing the Customized Common Industry Format Template for Electronic Health Record Usability Testing

http://www.nist.gov/itl/hit/upload/Guide_Final_Publication_Version.pdf