Health information technology may resemble other forms of hardware, software, systems, and services, but when the focus turns to usability that resemblance breaks down, according Jacob Reider, MD, of the Office of the National Coordinator for Health IT (ONC).
The outgoing head of the ONC — who’s set to return to his post as federal agency’s Chief Medical Officer when Karen DeSalvo, MD, MPH, MSc, assumes the role vacated by Farzad Mostashari, MD, ScM, in 2013 — has provided insight into how the usability of health IT differs from similar technologies in his latest post on Health IT Buzz.
“Early adopters of technology are well known to tolerate imperfections,” writes Reider. “Traditional market forces generally keep products that are difficult to use from succeeding, and as any user of an Apple Newton External Links Disclaimer remembers, the promise of an innovative solution isn’t always realized and will/should fail in the marketplace. Yet some have argued that the meaningful use incentive program altered market forces in a way that prevents well-intentioned products failing as did Apple’s first ‘personal digital assistant.’”
While the main thrust of Reider’s post is aimed at reiterating the ONC’s commitment to ensuring the improve usability of health IT, it also offers several distinctions about health IT usability that should remain part of the dialogue when discussing the design of these systems and services.
First, there is the matter of health IT selection. “The user isn’t always the buyer. This causes usability to be a less significant component of buying decisions,” he observes. Although best practices hold that clinicians ought to be made part of the selection process, this isn’t always the case and even still the final decision remains with those with purchasing power.
Second, health IT adoption is an ongoing process and nothing something easily switched. “Multi-year contracts and technical ‘lock-in’ cause portability to be a true challenge,” Reider explains. “One can’t just walk away from an EHR that’s not performing as expected. Buying and EHR is more like buying an airplane than a clock radio.”
Third, change is slow to come in healthcare:
Legacy software in a high-risk environment will evolve slowly – for good reason. One can’t change workflow or user experience too quickly, as changes in the user interface can increase error rates even if the new design is better for new users. Errors can harm or kill people. Developers need to evolve user experience slowly and carefully. Usability won’t improve overnight.
Lastly, there is the matter of implementing a health IT system to suit the requirements of a specific clinical environment itself:
Health IT systems are complex and require local configuration. Inadequate local resources can cause well-designed products to offer terrible user experiences. To the end-user, they have no way of knowing who is responsible — the IT department or the software developer? Was it Boeing or United Airlines who made these seats so uncomfortable?
It is certainly easy to knock the lack of usability for many health IT systems, with EHR technology serving as the most common whipping boy nowadays. However, getting to the root of the problem first requires an appreciation of how these systems are unique, an understanding that should meaningfully inform future decision-making when selecting new or replacement technology. Source
