Ok, technically, effective use of health IT begins with good product design, but (imho) technology vendors are not going to invest the time or money in user research and multiple design iterations to produce user-friendly products until their customers – YOU – demand it.
A few weeks ago, I made a presentation to the local chapter of the Health Technology Forum (HTF) suggesting six technology design principles of particular importance for making healthcare technologies more user-friendly. It was a great group – smart people, good questions. One participant asked me what I thought was needed to cause tech vendors to make usability a priority. At the time, I responded that as much as I hated to encourage regulation, I didn’t see health IT vendors making usability a priority until they were forced to do so by regulations similar to the FDA requirements for medical devices.
Since then, my thinking has changed. I now believe that the real leverage point for making technology work for healthcare lies within the procurement process. Rather than just choosing the least bad option from currently-available products (e.g., EHR, patient portal, CDS), I think technology buyers can – and should – raise the bar for usability!
Why should CIOs care about usability? Because poor usability is expensive!
“Executives don’t care about the users. They only care about money.” This was another participant comment during the same session. I don’t think that comment is true, and I do understand that ease-of-use (or “usability”) may feel like a luxury when considering all the other factors that go into a technology purchase decision. And if there’s a substantial price differential, concern over “tiny” differences in usability may be even tougher to justify. That’s why it is important that anyone with purchasing authority understands the hidden costs of poor usability – inefficiency, errors, and staff frustration, which further translate into decreased time with patients, increased risk of error, and lower patient satisfaction.
For now, let’s focus only on inefficiency. For ease of illustration, let’s assume your facility employees 100 nurses/shift x 3 shifts/day and that you’re evaluating EHRs to replace your existing system.
Usability clearly isn’t the only selection criteria, but it also isn’t a luxury. The sample calculation only addresses nursing labor costs. It doesn’t begin to touch on increased costs related to training and help desk calls, increased risk of error, and impacts on patient and physician satisfaction. A less expensive product with poor usability may end up costing you dearly in the end.
But how can I tell whether a product is user-friendly before we buy it?
You can begin by including tough questions and data requests in the RFP and in your vendor interview process. This will put vendors on notice that their customers are no longer satisfied with confusing interfaces and poor interoperability.
1. “Please describe your user-centered design process.”
A physician on the Board or Executive Team is not enough. Ideally, the product team would have begun with extended observations of clinicians in their respective work environments as the basis for defining the system requirements. Understanding lighting conditions, workflow, and other devices that will be used in conjunction with the target technology can lead to better design that will positively affect how readily staff adopt the new technology and how efficiently they will use it.
2. “How much usability testing was done on this product before it came to market?”
Ideally, a product will have undergone multiple rounds of usability testing. These might include evaluation of a paper-based prototype, of a real physical prototype, and of the final version of the product with time for revisions between rounds of testing.
3. “Do you have any comparative usability data we could review?”
If the company takes usability seriously, they will not only have usability data for their own product but will have data for comparable products as well. This is common practice in online retail, but it is unlikely any current health IT vendors will have this data. Asking the question will, however, send a signal that usability matters.
4. “Would you be willing to provide us with a demo version we could use for comparative usability testing on-site with our own staff?”
Brace yourself – this one might be a deal breaker. If the vendor refuses to make a demo available for comparative testing, chances are they know their product will perform poorly. You can thank them for helping you dodge a bullet!
Your best bet, is to actually test the products. A trained usability professional can evaluate the product against a set of standard design criteria (called a “heuristic evaluation”) or can facilitate structured usability testing by members of your staff. It’s a small investment of both time and money that could save your organization millions over the life of the system.
No product is perfect. An EHR that has a very user-friendly physician interface may not work as well for the nurses. Or the surgery module may be fantastic but the outpatient module is clunky. There will be trade-offs. With an expert review or actual user-testing, however, you can make informed decisions about which trade-offs you’re willing to make.
Does your procurement process include usability criteria? Does it “raise the bar” for health IT ?