1. Usability and Human Factors Unit 6b Electronic Health Records and Usability

2. Usability Concepts and Examples The slides with black backgrounds following are courtesy of Dr. Jeffrey Belden http://www.toomanyclicks.com Component 15/Unit 6b2 Health IT Workforce Curriculum Version 1.0/Fall 2010

3. Simplicity Component 15/Unit 6b3 Health IT Workforce Curriculum Version 1.0/Fall 2010 Not just spare design Appropriate information density Difference between complex and complicated Not just spare design Appropriate information density Difference between complex and complicated

4. Component 15/Unit 6b4 Health IT Workforce Curriculum Version 1.0/Fall 2010 Simplicity

5. Naturalness Component 15/Unit 6b5 Health IT Workforce Curriculum Version 1.0/Fall 2010 How automatically ‘familiar’ and easy to use it feels to the user Different for different contexts EHRs: little time for training How automatically ‘familiar’ and easy to use it feels to the user Different for different contexts EHRs: little time for training

6. Component 15/Unit 6b6 Health IT Workforce Curriculum Version 1.0/Fall 2010 Naturalness

7. Component 15/Unit 6b7 Health IT Workforce Curriculum Version 1.0/Fall 2010 Naturalness

8. Consistency Component 15/Unit 6b8 Health IT Workforce Curriculum Version 1.0/Fall 2010 External How similar to other applications the user knows (lower learning curve, errors) Internal Same across different situations External –How similar to other applications the user knows (lower learning curve, errors) Internal –Same across different situations

9. Component 15/Unit 6b9 Health IT Workforce Curriculum Version 1.0/Fall 2010 Consistency

10. Minimize Cognitive Load Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 10 Perception, attention, memory are limited Less attention to system means more available for medical tasks Decrease memory use Present all information needed for task on same screen Recognition, not recall Perception, attention, memory are limited Less attention to system means more available for medical tasks Present all information needed for task on same screen –Decrease memory use Recognition, not recall

11. Minimize Cognitive Load (cont.) Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 11 Organize by meaningful relationshipsDecrease excessive navigation Don’t make the user wonder “How do I? Where is…?”, “What does this do..?” Transparency: Adequate cues for data entry e.g. visual display Perception, not computation Organize by meaningful relationships Decrease excessive navigation Transparency: –Don’t make the user wonder “How do I? Where is…?”, “What does this do..?” Adequate cues for data entry Perception, not computation –e.g. visual display

12. Minimize Cognitive Load Same information presented graphically allows easy detection of patterns & perception, not calculation Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 12

13. Component 15/Unit 6b13 Health IT Workforce Curriculum Version 1.0/Fall 2010 Minimizing Cognitive Load

14. Component 15/Unit 6b14 Health IT Workforce Curriculum Version 1.0/Fall 2010 Minimizing Cognitive Load

15. Component 15/Unit 6b15 Health IT Workforce Curriculum Version 1.0/Fall 2010 Minimizing Cognitive Load

16. Component 15/Unit 6b16 Health IT Workforce Curriculum Version 1.0/Fall 2010 Minimizing Cognitive load

17. Efficient Interactions Minimize steps required –Shortcuts for experienced users Auto tabbing, good defaults, appropriately changeable, limit scrolling (e.g large text/list boxes), prevent switch between keyboard and mouse Minimize visual search Minimize distance cursor travels (Fitt’s law) –Both lead to user fatigue & frustration Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 17

18. Component 15/Unit 6b18 Health IT Workforce Curriculum Version 1.0/Fall 2010 Dashboard Efficiency

19. Forgiveness and Feedback Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 19 Clear messages, clear ability to see system status e.g. action had desired result Reverse actions without penalty Facilitate learning Interrupt handling, don’t lose information, work Clear messages, clear ability to see system status –e.g. action had desired result Reverse actions without penalty Facilitate learning Interrupt handling, don’t lose information, work

20. Effective Use of Language Component 15/Unit 6b20 Health IT Workforce Curriculum Version 1.0/Fall 2010 Concise, unambiguous, familiar to usersNot computer terminologyNot upper case except in rare contexts Only commonly understood abbreviations and acronyms Concise, unambiguous, familiar to users Not computer terminology Not upper case except in rare contexts Only commonly understood abbreviations and acronyms

21. Effective Use of Language (cont.) Component 15/Unit 6b21 Health IT Workforce Curriculum Version 1.0/Fall 2010 e.g. ellipsis… Indicate clearly further information JCAHO has list of forbidden abbreviations (can cause errors) Presentation of structured terminology is complex, area of research DS, eliminating redundancy, admin/reporting, identify clinical relationships, etc. Structured terms used for many functions: Indicate clearly further information –e.g. ellipsis… JCAHO has list of forbidden abbreviations (can cause errors) Presentation of structured terminology is complex, area of research Structured terms used for many functions: –DS, eliminating redundancy, admin/reporting, identify clinical relationships, etc.

22. Component 15/Unit 6b22 Health IT Workforce Curriculum Version 1.0/Fall 2010 Doctor and Patient

23. Effective Information Presentation Component 15/Unit 6b23 Health IT Workforce Curriculum Version 1.0/Fall 2010 Appropriate density: Myth: less dense is better Staggers 1997: nursing interface had more efficiency/lower errors with more density Key is less visual search, organization, drill- down/summarization as appropriate Juxtaposition of related items e.g. INR/coumadin, systolic and diastolic together Appropriate density: –Myth: less dense is better Staggers 1997: nursing interface had more efficiency/lower errors with more density –Key is less visual search, organization, drill- down/summarization as appropriate –Juxtaposition of related items e.g. INR/coumadin, systolic and diastolic together

24. Component 15/Unit 6b24 Health IT Workforce Curriculum Version 1.0/Fall 2010 Effective Info Presentation

25. Information Presentation Color: use to convey meaning, not decoration Consistency of color meaning Use number of colors user can remember Don’t contradict conventions –e.g. red=danger, stop; green=ok, go Section 508: 8% of male users are colorblind Convey color meaning with a secondary method –e.g. underlining Component 15/Unit 6b25 Health IT Workforce Curriculum Version 1.0/Fall 2010

26. Color Meanings (US) Component 15/Unit 6b26 Health IT Workforce Curriculum Version 1.0/Fall 2010 Red: Stop, Hot, Danger, Error, Extreme Warning, Severe Alert, Emergency, Alarm Yellow: Caution, Potential or Mild Warning, Requires Attention, Slow, Moderate Alert Green: Go, Safe, Normal, Good, Proceed Blue: Cold, Advisory Red: –Stop, Hot, Danger, Error, Extreme Warning, Severe Alert, Emergency, Alarm Yellow: –Caution, Potential or Mild Warning, Requires Attention, Slow, Moderate Alert Green: –Go, Safe, Normal, Good, Proceed Blue: –Cold, Advisory

27. Readability Must be able to scan quickly with high comprehension 12 point or greater, always >9point Allow users to change font size –Visual impairments in much of the population –i.e. respect system settings for color, size, font Sans serif most readable on computer screens Black on white most readable Component 15/Unit 6b27 Health IT Workforce Curriculum Version 1.0/Fall 2010

28. Preservation of Context Interruptions abound –Minimize visual interruptions Direct responsiveness –i.e. user should be able to tell immediately what is happening Avoid ‘modes’ –e.g. data entry mode v. viewing Data entry should be directly available if allowed Component 15/Unit 6b28 Health IT Workforce Curriculum Version 1.0/Fall 2010

29. Component 15/Unit 6b29 Health IT Workforce Curriculum Version 1.0/Fall 2010 Preservation of Context

30. Component 15/Unit 6b30 Health IT Workforce Curriculum Version 1.0/Fall 2010 Medication, Weight, and BP

31. Basic methods Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 31 Listen to the users Don't listen to the executives Listen to what they do Don't listen to what the say Give them what they need Don't give them what they ask for Don't listen to the executives –Listen to the users Don't listen to what the say –Listen to what they do Don't give them what they ask for –Give them what they need

32. Continuum of Usability Has personal significance Meaningful Memorable experience worth sharing Pleasurable Super easy to use, works like I think Convenient Can be used without difficulty Usable Is available and accurate Reliable Works as programmed Functional (Useful) Component 15/Unit 6b32 Health IT Workforce Curriculum Version 1.0/Fall 2010 Meaningful –Has personal significance Pleasurable –Memorable experience worth sharing Convenient –Super easy to use, works like I think Usable –Can be used without difficulty Reliable –Is available and accurate Functional (Useful) –Works as programmed

33. The First Cars Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 33

34. Cars From the Fifties Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 34

35. Modern Cars Component 15/Unit 6b35 Health IT Workforce Curriculum Version 1.0/Fall 2010

36. Rotary Phone Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 36

37. First Cellular Phone Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 37

38. Phones Today Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 38

39. Resources Research ‐ Based Web Design & Usability Guidelines –http://www.usability.gov/pdfs/guidelines.htmlhttp://www.usability.gov/pdfs/guidelines.html Ui-patterns.com –http://www.ui-patterns.comhttp://www.ui-patterns.com Mscui.net –Open source standards for medical information display created by National Health Service (Britain) through a rigorous process –http://mscui.nethttp://mscui.net Joint Commission: official ‘Do Not Use’ abbreviations list: –www.jointcommission.org/NR/rdonlyres/2329F8F5-6Ec5-4E21- B932-54B2B7D53F00/0/dnu_list.pdfwww.jointcommission.org/NR/rdonlyres/2329F8F5-6Ec5-4E21- B932-54B2B7D53F00/0/dnu_list.pdf Too Many Clicks –http://www.toomanyclicks.comhttp://www.toomanyclicks.com –Discusses EMR usability, author is Dr. Jeffrey Belden Component 15/Unit 6b Health IT Workforce Curriculum Version 1.0/Fall 2010 39