assessing ehr implementation decisions to improve ... · –outcome: impact of ehr upgrades on...
TRANSCRIPT
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Assessing EHR Implementation Decisions to Improve Usability and Reduce Burden for Clinicians
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PRESENTERS
• Jonathan Wald, MD, MPH Director of Digital Health, RTI International
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• Laura Marcial, PhD Health Research Scientist, RTI International
• Aaron (Zach) Hettinger, MD,
MedStar Health National
Center for Human Factors in
Healthcare
• Raj Ratwani, PhD
Director of the MedStar
Health National Center for
Human Factors in
Healthcare
• Justin Cross, MD ONC Medical Director for Systems Safety, US Department of Health & Human Services
• Moderator: LaVerne Perlie MSN, RN ONC Health Scientist, US Department of Health & Human Services
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Project background
• Jonathan Wald, MD, MPH Director of Digital Health, RTI International
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EHR Users are facing critical usability problems
• Go-live is just the beginning!
» Many usability problems surface after an EHR is in regular use
» Making changes, and testing the changes to improve usability, are essential
activities
» Medium-to-low-resource practices have limited time and know-how to address
usability challenges
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What is Usability?
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» Part of the scientific discipline of
human factors.
» Can be measured quantitatively by
examining error rates and time-on-
task, and can be assessed qualitatively
by talking with users.
• Usability: the extent to which a system supports a user to
efficiently and effectively achieve desired goals 1
1 ISO 9241-11; https://www.iso.org/obp/ui/#iso:std:iso:ts:20282:-2:ed-2:v1:en
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EHR Users are facing critical usability problems
• Ratwani et al (2016) findings from interviews and a literature review on usability and EHR implementation:
» Products implemented differed considerably from products demo’d
» Few practical tools to identify usability-related safety issues
» EHR customization not informed by human factors principles can add to risk
» Workflow decisions are often uninformed by best practices
» Limited improvements or ongoing training after go-live are typical
• Smaller healthcare practices and institutions need to:
» Select products with high marks for UCD
» Implement with appropriate expertise and support
» identify EHR aspects that should be customized
» identify and ameliorate usability-related issues in implemented systems
6 Ratwani R et al.: Review to identify usability and safety challenges and practices during EHR implementation. Appl Clin Inform 2016; 7: 1069–1087. http://dx.doi.org/10.4338/ACI-2016-06-R-0105
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To promote usability…
• A Change Package is being developed
» To collect and present resources that enable and accelerate usability
improvements
» Targeted toward users who are EHR implementers and QI project leaders
» Serving practices having medium-to-low resources
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Project approach
• Resources
» Identify and collect an initial set of
resources
– Publicly available
– Helpful to non-experts
» Test those resources in-the-field
» Produce a Final Change Package and
guide for its use, including case
examples
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Project activities
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• Project team
» RTI International | Medstar | Clinovations Government+Health
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• Raj Ratwani, PhD
Director of the MedStar
Health National Center for
Human Factors in
Healthcare
Usability IRL (in real life)
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What does Usability look like in the clinical environment?
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Photo credit to Bob Wears, MD, PhD
User Interface Design Context Independent
Font Sizes Icons
Colors & Contrast Layout
Cognitive Task Support Context Dependent “Workflow Design”
Visualization Memory Aids
Error Anticipation
Photo Credit: Bob Wears, MD
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Resource Gaps
• General lack of applicable tools and resources
• Lack of detailed, step-by-step “how to” guidance
• Variability of user need
Roles
Administrative Expertise Clinical Expertise
Informatics Expertise Usability Expertise
Practice Manager
Physician
Informatics RN
Director of Informatics
CMIO
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Optimization through the Change Package
• Step-by-step vignettes to demonstrate tool usage
• Design around variable user needs
Learn about Usability
Identify Problems and Approaches
Identify Tools and Implement
Introduction & EHR Checklist
Preparing For Change Problem Finding Locating a Tool
Implementing a Tool
Additional Resources
Practice Manager
Physician
Informatics RN
Director of Informatics
CMIO
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• Laura Marcial, PhD Health Research Scientist, RTI International
The Usability Change Package (UCP)
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Usability Change Package: Introduction and Navigation
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• Aaron (Zach) Hettinger, MD,
MedStar Health National
Center for Human Factors in
Healthcare
UCP Test sites
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Test Sites Overview
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Care Setting Population Served Resource Availability End User(s)
1 Ambulatory Suburban Lower • Practice Manager
• Physician
2 ~100 Bed Hospital Suburban/Rural Higher • Director of IT
• Clinical Informatics
Specialist
3 Ambulatory Rural Lower/Moderate • Regional Medical
Director
4 ~700 Bed Hospital Urban Higher • CMIO
• Nursing Informaticist
• Clinical Performance
Specialist
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Site Familiarity with EHR Usability
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How long have you been at your currentposition?
How long have you been involved withimplementing or optimizing electronic
health records?
Do you have any formaltraining in
implementing/optimizingelectronic health records?
How familiar are you with the term"usability" as it relates to electronic health
records?
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Survey Responses (N = 9)
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Site-Specific Projects
Site 1: Project: Optimizing the workflow of communication around surgical
orders and scheduling
– Outcome: Changed internal workflow, Vendor Collaboration
Site 2 Project: Implementing EHR radiology Clinical Decision Support (CDS)
– Outcome: EHR Upgrade Challenges, Regulatory Coordination
Site 3 Project: Effect of EHR Upgrades on Colon Cancer Screening
– Outcome: Impact of EHR upgrades on quality metrics, Increased awareness
for near-future EHR conversion
Site 4 Project: Integration of a patient transportation communication system
integrated into the EHR to prevent delays and patient safety events.
– Outcome: Assessment of EHR Usability, *Pending data analysis
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Lesson Learned from Sites
• Workflow analysis and data collect assists assisting with optimization
• Role of EHR with quality metrics
• Coordination with EHR improvements and regulatory requirements
• Communication between the healthcare organization and the EHR vendor is critical to success
• Unintended consequences of EHR software upgrades on usability improvements
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• Justin Cross, MD ONC Medical Director for Systems Safety, US Department of Health & Human Services
ONC Comments
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QUESTIONS AND DISCUSSION
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@ONC_HealthIT @HHSONC
THANK YOU FOR YOUR PARTICIPATION FOR MORE INFORMATION:
Jonathan Wald, MD, MPH | [email protected]
Zach Hettinger, MD MS | [email protected]
Laura Marcial, PhD | [email protected]
Raj Ratwani, PhD | [email protected]