My first ever job was at my dad’s medical practice scanning paper records into the brand new electronic medical record system. Looking back, I remember what an exciting season of life those four years were…NOT (scanning an endless pile of paper is not fun).
This was around 2008, when lots of medical practices and hospitals were just starting to transition from paper to electronic. Seven years later, we’re well into the age of EMR. The industry use of EMR went from 60% in 2012 (when I finally quit my job) to 90% in 2014 (when I landed my current job in IT staffing). The gradual transition from paper to digital should be nearing an end…but if I learned anything in my four years in the medical field, it’s that the health care system—and often the people in it—are slow at adapting to change.
Electronic medical records are necessary in the modern world, and many doctors, nurses, and patients have been empowered because of them. However, there’s also increasing distrust of digital systems. Small annoyances, like “too many clicks,” frustrate users, while things like hacks, crashes, and possible “alert fatigue” worry them. Some even go so far to claim that badly designed electronic medical records can kill you.
Talk about putting pressure on health IT workers—but however exaggerated the worries may be, it just goes to show that the relationship between designer and user may be more important in this software niche than any other. Problem is, you might never have the opportunity to sit in a medical office and observe your product in use.
So from me to you in health IT, here are a few things I learned as a 4-year-long user, and observer of those using EMRs:
People are Slow to Change
As I already mentioned, the people in my office were slow to take on the new EMR system. One doctor was so resistant to change that he continued writing all his notes by hand, and his already fully-tasked assistant would type them up into the EMR. His was a case of extreme stubbornness, but in general the healthcare system is recognized as slow-changing. Bonny Roberts, VP of customer experience at Aventura, writes for HIMSS, “I frequently hear colleagues, partners and customers talk about how slow healthcare is to change. It is true, healthcare is a big ship; yet I don’t blame the individuals and organizations for the industry’s microscopic course alterations. In the field of healthcare, and particularly when it comes to workflow, there is a strict doctrine of behavior that has been passed down for decades.”
My suggestion for developers is to remember that your user likes slow change. Frequent, gradual, and subtle software updates were always received better around the office than big, sudden changes—big changes would send everyone into a tizzy.
Work Toward Intuitive Interfaces
Last September the AMA called for a design overhaul of electronic health records to improve usability. Said AMA President Steven Stack, M.D., “Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work,” He goes on, saying, “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”
If you’re a EMR developer and you’ve received feedback like this from your users, you’re not alone—clearly there’s a industry pattern of dissatisfaction. (To be fair, Dr. Stack recognizes that not all usability issues are related to software design; some are a result of institutional policies and bad training.) A possible solution: get user feedback—doctors, nurses, administrators, and otherwise—at multiple stages of the design process. “Designers should use the principles of good design to give doctors an intuitive EMR system that can be learned in minutes.” When users have the understanding, confidence, and power to use a product efficiently, they can have more face-to-face discussions with patients rather than being bogged down by clicks, unnecessary steps, and clerical work.
Researchers say that physicians have increased satisfaction when given more autonomy and control over the way they practice, including the pace and content of patient care. Increased satisfaction of your user should be one of your main goals as a software designer.
Strong Support Staff is Important
Make sure your product is strong by making sure your team is strong. A large network of people rely on your product, and if a glitch or security breach occurs, the burden falls on you. One of our clients, Flexis (of sister company Open Medical Institute) invests a lot is very invested in the strength of their team.
Many teams find strength in different ways because no two teams are the same, but for one developer’s point of view on what made the difference between good and great teams, look here.
You’re Helping Save Lives
As a software developer, you might not think of yourself as someone who saves lives—but that is what you’re doing. EMR is an irreversible and necessary change, and will make our healthcare system more efficient and effective than ever before.
Even though there’s been resistance to change, recent HIMSS Analytics reported that, “Over 70 percent of hospitals have made positive progress in the advancement of their EHR capabilities over the last five years, and over 60 percent of ambulatory facilities have shown positive progress in just the last three years. This advancement confirms the impact across the community of improving the experience of care, enhancing patient engagement initiatives, better care coordination, and other benefits to our delivery system.”
Have anything to add? What ways do make your EMR user friendly?