Coordination is the name of the game these days in healthcare. Healthcare delivery reform, such as the forming of accountable care organizations (ACOs), has providers working to improve patient care by streamlining care coordination. The push for patient engagement has healthcare organizations and providers taking to patient portals and other forms of provider-patient interaction to better coordinate communication.
Another area of coordination that is perhaps secondary to these already mentioned is the coordination taking place between physicians and health IT engineers in the development of mobile EHR applications and services. The penchant of physicians for using mobile devices and smartphones have forced their organizations and health IT vendors to consider what implications mobile EHR and health (mHealth) is having and will have on clinical workflows.
“We went with iOS because that’s what our physicians asked for,” says Amanda Buckley, Senior User Experience Lead at Cerner. “They already own their own personal iPads. Those are what they use in their personal lives, then they were bringing them into the clinical environment and they could only do their email. That was a roadblock.”
The benefits of going mobile for physicians are rather obvious: increased mobility and ease of use. Cumbersome computers on wheels (COWs), slightly less clumsy laptops, or stationary desktop PCs represent barriers to getting comfortably to the point of care where the patient will benefit most from the use of health IT.
The balancing act for mobile EHR designers is determining what features and functionalities need to be available to clinicians working with tablets and in an ecosystem engineered for lightness.
“With the tablet, it provides them the ability to what they do 80 percent of the time anywhere instead of just on the device,” explains Buckley. “Right now we’re not 100 percent everything in your workflow is on the mobile device.”
What’s holding back the tablet ubiquitously replacing the desktop computer is an appreciation of the differences between mobile and desktop computing and where each excels at or falls short of delivering meaningful results. Choosing which features appear on which device is the direct result of designers working closely with clinicians to design based on the latter’s workflows and avoid throwing everything but the kitchen sink into the mix without asking why:
From a design perspective, I find that nine times out of ten all those things got in there because as a researcher, designer, or solution you don’t take the extra time to ask why. They say they need it because they do x, y, or z, but once you really get to the root of what they’re trying to accomplish in that workflow, most likely they actually don’t need that. That’s been a big change for all of our research gathering at Cerner — always questioning the underlying need because unfortunately many times clinicians don’t know what they need.
For mobile EHR to be effective, it’s ideal that it remain light and uncluttered. This realization is not often obvious to users, which is why coordination between EHR designers and end-users is so fundamental. As Buckley observes, “Being able to have that conversation with the clinicians and get to where they understand that that’s not perhaps the best approach and don’t have the complications from adding in all that fluff which causes the interface to ultimately become less usable — just more clutter on the screen.”
Making clinicians a valuable part of the development cycle requires flexibility on the part of EHR designers and engineers. Doing so in an agile development environment with tight timelines and windows for turning products around raises the stakes for EHR companies.
“Many have gone over to agile but really struggle with how to get users involved in an agile environment that is two four-week iterations before engineers are coding,” explains Buckley. “What we’re doing is blending a user-centered design with agile. All that means is pushing out the design phase before engineers start so that we don’t all start at the same time.”
Ultimately, developing a successful mobile EHR application comes down to identifying what users want and designing with users in mind. “Give them a rich experience they’re already used to because then that drops the learning curve,” says Buckley.
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