What is health experience design and why do EHRs need it?
I had the opportunity last week to attend the first-ever Health Experience Design conference in Boston. This innovative conference focused on the issues surrounding designing healthcare applications to meet the needs of patients and providers for collaboration, communication, efficiency, user satisfaction and most of all, improving patient safety. In IDC-HI's evaluations of clinical applications including EHRs, the issue of usability comes up frequently, and providers using clinical applications stress the importance of the EHR application's fit (or lack thereof) to their workflow and clinical practice as a key factor in eventual adoption and value. At the same time, it is quite clear that usability means different things to different users and application designers. The discussion at the conference focused on defining design for the care experience, factors that should be considered, and what can be done to improve design and subsequently the experience of patients and providers in the digital healthcare environment.
With the advent of stimulus incentives and the upcoming implementation of healthcare reform, the digital healthcare environment is fast becoming a reality. However, it is increasingly clear from my ongoing work with the applications at the center of digital care delivery, EHRs, that the design of applications that facilitate the digital health experience is often far removed from the needs of users who deliver care, and the workflow and processes in their care environment. With much of the focus of the past 2-3 years on meeting requirements for functionality to support meaningful use and/or certification, EHR designers have not paid enough attention to the aspects of their applications which address the provider and patient experience. The origins of many EHR products, as clinical add-ons to legacy financial and administrative systems, create design issues. EHRs need to retain continuity (and often common architecture) with the financial, administrative and departmental applications in the hospital, and this may limit the capabilities that can be used when designing EHRs.
Healthcare experience design in the EHR space presents contradictions. Providers want usable applications and cite this as their top concern when selecting EHRs. When EHR implementations fail, usability and efficiency are the most common reasons given. Yet clinical practice patterns vary among providers, and this means that the assessment of both usability and the fit of an application to a clinical workflow is quite subjective. An application that "thinks the way I think," for one provider, may not for another. Providers want configurable applications that can adapt to their practice patterns, and frequently prefer screen designs that echo existing paper charts. This clearly limits design. Providers define usability in the context of their clinical practices, and not according to application design principles. It often seems that for every provider who considers a particular application highly usable, there is another that does not. The subjective nature of usability presents a problem for application designers, particularly when faced with the functionality demands of the current regulatory climate and the limited focus and resources available for design.
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