Can the usability barrier be overcome?

At the workgroup meeting of the Health IT Policy Committee on Adoption/Certification last week, the hot topic was usability--or rather the lack of usability at times found among current electronic health record (EHR) systems.

One point of agreement among the panelists is that usability is not a one-size-fits-all topic. In her testimony, Chantal Worzala, director of policy at the American Hospital Association (AHA), best described EHR usability as the way in which EHR products "help clinicians and others complete care delivery tasks well, efficiently and in a way that is satisfactory."

As others have noted, she said, usability is an important factor in the pace of EHR adoption and has been identified as a barrier to increased adoption. "Put simply, if a system is not easy to use, it is less likely to be used."

For EHR products that are used in hospitals, Worzala said, two levels of usability should be considered: usability of the individual product and usability of the system as a whole.

That means that as EHR vendors try to improve usability, they need to look at both the use of their individual product--and "how their product fits into a hospital's broader information systems," she noted. This could include areas such as workflow, navigation, screen layout, interaction and visual design, and ease of connectivity with other parts of the system.

But getting the industry to think more about usability issues may take some effort, according to Bill Hashmat, CIO and co-founder of CureMD, a network of health information management systems and services. "Cumbersome system design" is proving to be the "biggest threat" to the federal stimulus investments designed to promote the adoption of EHR systems.

Making usability "a key focus of the certification program" from The Office of the National Coordinator for Health IT will ensure that HIT investments would bring promised results, he said.

However, a roadblock arises in that no formal usability testing procedures are available in the industry: few vendor organizations have active usability personnel on staff, Hashmat said. And the current work that is being done on usability is not systematic.

In addition, no one measurement strategy will solve all things--"just as no one medical test will tell you the condition of the patient," said Ben Shneiderman, a professor at the University of Maryland and founding director of the Human Computer Interaction Laborabory.

"Sometimes you need a blood test. Sometimes you need an X-ray," he said. "Same things for usability. We have many many ways of doing usability, and we need to invoke these multiple strategies."

Help may be on the way through such efforts now being undertaken at the National Institute for Standards and Technology (NIST). The organization is currently developing a set of procedures that will be repeatable for evaluating, testing and validating the usability of EHRs and other health IT systems, noted Lana Lowry, NIST's health IT usability project lead.

"Usability is a key factor in Meaningful Use because at the end of the day, no one can be satisfied with a system in which the system itself is a contributing factor to an error in patient treatment," Lowry said. In the long-run, it will be essential that "meaningful users"--such as physicians, medical technicians, nurses, administrative staff and others--be able to successfully "access, retrieve, process, and act on data easily, without error, and without excessive time burden."

As National Coordinator Farzad Mostashari, MD, said at the meeting: "All too often we hear from providers that they look forward to the day when the technology works for them instead of them working for the technology."

So what are we waiting for? - Janice