1. EHR Usability Standards, Tools and Frameworks Muhammad F Walji, PhD University of Texas Health Science Center Houston, TX

2. Patient-Centered Cognitive Support Jiajie Zhang, PI University of Texas Health Science Center at Houston Challenges Usability Workflow Cognitive Support SHARPC Research 1. EHR usability and workflow: Evaluation and Design 2. Cognitive support for clinical comprehension 3. CDS adaptation to local settings 4. Automated Clinical Summarization 5. Cognitive information design and visualization Products Tools and Methods Exemplar Interfaces Best Practice Guidelines

3. ISO Definition of Usability Extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use ISO 9241: Ergonomics of Human System Interaction

4. SHARPC Definition of Usability Usability refers to how – useful, – usable, – satisfying a system is for the intended users to accomplish goals in the work domain by performing certain sequences of tasks Zhang J, Walji MF. TURF: Toward a Unified Framework of EHR Usability. Journal of Biomedical Informatics. 2011 Dec;44(6):1056-67. 4

5. TURF Framework for EHR Usability Electronic Health Record System Usability Functions Users Representations Tasks Useful Usable Satisfying Intrinsic Complexity Extrinsic Difficulty Zhang, J., & Walji, M. F. (2011). TURF: Toward a unified framework of EHR usability. Journal of Biomedical Informatics, 44 (6), 1056-1067 5

6. State of EHR Usability Senate panel to look into EHR usability 'After $28 billion in taxpayer dollars spent subsidizing electronic health records, ‎doctors don't like these electronic medical record systems.’ Unhappy with the state of electronic health records across the country two U.S. Senators have decided to take the matter into their own hands.

7. Understanding Users and their Work User-centered Design User Analysis User Personas Work Domain Analysis

8. Guidelines and Inspirational Prototypes General Usability Design Principles https://sbmi.uth.edu/nccd/ehrusability/design/guidelines Safety Enhanced Design Briefs https://sbmi.uth.edu/nccd/SED/Briefs/ Inspired EHRs: Designing for Clinicians http://inspiredehrs.org/ http://inspiredehrs.org/ Twinlist: A Multi-Step Interface to Reconcile Medication Lists http://www.cs.umd.edu/hcil/sharp/twinlist/index.shtml http://www.cs.umd.edu/hcil/sharp/twinlist/index.shtml

9. Formative and Summative Evaluations Heuristic Evaluation – Extend to include accessibility heuristics User Testing – User Testing Scenarios – Representative Users

10. Governmental Responsibilities NIST Technical Guidance for EHR Usability http://www.nist.gov/healthcare/usability/ Office of National Coordinator (ONC) – Safety Enhanced Design AHRQ https://healthit.ahrq.gov/

11. User/Buyer Responsibilities Active role in helping to design and evaluate Health IT systems Embed usability/accessibility into procurement process

12. Lessons Learned from EHR Usability Shared Responsibility – Health IT Vendors – Academics/Researchers – Users / Stakeholder groups – Government No quick fixes

13. Thank you! Better EHR: Usability, workflow and cognitive support in electronic health records https://sbmi.uth.edu/nccd/better- ehr/index.htm Email: Muhammad.F.Walji@uth.tmc.edu Muhammad.F.Walji@uth.tmc.edu