The Usability People, Inc.

06/22/2020

ONC Changes requirements for 2015 Cures Update Certification

Summative testing for the 2015 Cures Update certification now needs to test the following 9 areas:

Section 170.315(a)(1) Computerized provider order entry – medications
Section 170.315(a)(2) Computerized provider order entry – laboratory
Section 170.315(a)(3) Computerized provider order entry – diagnostic imaging
Section 170.315(a)(4) Drug-drug, drug-allergy interaction checks
Section 170.315(a)(5) Demographics
Section 170.315(a)(6) Problem list
Section 170.315(a)(14) Implantable device list
Section 170.315(b)(2) Clinical information reconciliation and incorporation
Section 170.315(b)(3) Electronic prescribing

Visit https://www.theusabilitypeople.com/webform/cures-update-summative-usability-evaluations-safety-enhanced-design for info...

The Usability People conduct and report summative usability evaluations using the NISTIR 7742 Customized Common Industry Format Template for EHR Usability Testing. These reports are suitable for presentation to an ONC-ACB, such as Drummond, InfoGuard, etc. for Meaningful Use Stage 2 (2014) Certifica...

02/06/2020

People are all too quick to blame themselves for not being able to use a poorly designed (or tested) system. We call this the "Fallacy of User Error."

Nothing can be further from the truth. There is nothing wrong with the users. It doesn't matter that they are not "tech-savy." A well-designed app should be built to match the mental model of it's users--tech savy or not!

Users shouldn't blame themselves because your app or system has a priority one bug. If your design causes the user to make mistakes, don't blame the users, learn from them and then design your system to match their way of working.

So why do the user's blame themselves? As usual, we turn to the theories of Psychology to guide our understanding of user interface issues, this time it is the concepts of Habituation and Learned Helplessness.

People are creatures of habit and will tend to try to do things that they have learned in one application (or website) when they encounter another. Their “mental model” will eventually guide their default interaction with your site. If the site or app isn't built to match that mental model, the users may be likely to make more errors.

Don't blame your users for a design flaw.

Some non-tech savy users may feel helpless and as a result many have learned to lean on their friends or co-workers for help. We recommend that these users follow a “cheat sheet” designed to help them 'get the job done' without ever branching off and exploring the interface.

01/14/2020

In a recent blog post by John Lynn, John discusses the irony of the following two statements:

EHR Training Improves EHR Satisfaction and
Physicians Don’t Want to Make Time for EHR Training

Many, many times in our usability evaluation and design career when a development team isn't really interested in making enhancements to fix specific issues that we've identified, we've heard something like the phrase, "There is nothing wrong with the user interface, it is a training issue."

This very engineering-centric attitude is all too prevalent. These teams are more interested in getting any product out the door, and are not interested in supporting the needs of real people that have to use it.

"THEY (the users) can't figure out how to use it, so THEY need training."

A key component of the Human-centered Design paradigm is empathy. Empathy and understanding of real user's needs leads to a product that can match the mental model and workflow of users.

The theories of Jean Piaget can also be applied to understanding the reasons why many EHRs are just too hard to use and why they require so much training. According to Piaget, people are born with a very basic mental structure or schema on which all subsequent learning and knowledge is based.

Medical professionals have many schemas they use in their practice. Seeing and treating a patient can most often follow a set pattern, or workflow: The patient arrives, vitals are taken then entered into the patient record, the doctor consults with the patient, possibly orders tests, or prescriptions, etc.

So, what happens when the real world does not match an existing schema? As we gain more experience with the world, our schema must evolve via the processes of learning. According the Piaget the learning takes place via the processes of Assimilation and Accommodation.

Assimilation occurs when you can take an existing mental structure and easily incorporate it into understanding a new event or system. Assimilation does not cause much cognitive load on the person, as they are using an already existing mental structure to understand things.

Accommodation occurs when you must change your mental structure in order to understand and incorporate a new event. Accommodation requires much more of a cognitive load than assimilation, as it requires you to ‘rewire’ your brain and update or create a new mental structure to understand the event.

But, basic functionally of the system should be easy for users without training. EHR users should be able to assimilate, not forced to accommodate, the basics of using the EHR into their current mental structure.

When we design EHRs that make "more sense" to physicians, they will not need as much basic training. Physicians can instead use training to leap-frog the transition from a novice to expert user by learning from the Subject Matter Expert. Having a subject matter expert discuss the ins-and-outs of a system, and provide various best practices and work-a-rounds to get the job done can be very valuable. Maybe with this schema physicians will not be so resistant to training.

While at the CHIME 2019 Fall Forum conference in Phoenix, AZ, I had a great chance to sit in on one of the CIO focus groups at the event hosted by Optimum Healthcare IT. The session discussed a wid…

12/13/2019

A Bad UX can cause Death by 1000 cuts

"It is just a simple drop-down list, it isn't necessary to sort." We were told.

Each time a decision is made to not optimize a UI to be Effective Efficient and Satisfying (in a specific context of use)-- no matter how small-- is a "cut." "Death by one thousand cuts," aka LingChi' even has it's own WIKI page.

The ISO 9241 standard presents the definition of usability as Effective Efficient and Satisfying in a specified context of use.

11/27/2019

When you design for the people that use your product - people will use your product!

Section 508 and Human-Centered Design -- We've often blogged about Section 508 compliance as a means to convince very engineering-centric developers to consider their users.

Accessible designs work for everyone - Ever use a curb-cut!?

By thinking about a disabled user and designing a solution that works for them, developers adopt a human-centered design strategy without even knowing it.

It is an excellent foot-in-the-door for designing for an admin user, a casual user, the sales team, an expert user, and many of other personas associated with the solution.

11/25/2019

LETS FIX THIS:

When it comes to usability, doctors give electronic health record (EHR) systems an “F”. And that poor usability correlates with physician burnout, according to a study published in Mayo Clinic Proceedings.

Researchers surveyed 870 U.S. physicians about EHRs and asked them to rank system usability with a score of 0 to 100. The mean score was 45.9, which is in the “not acceptable” range or a grade of an 'F', the study said.

See

When it comes to usability, doctors give electronic health record systems an “F.” And that poor usability correlates with physician burnout, according to a study published today in Mayo Clinic Proceedings.

10/17/2019

or It doesn’t matter what you call it -- designing to match the mental model and of real users is ALWAYS a good idea! Plus the in is measured in lives!

08/13/2019

Zubin .. aka always has great things to say. It is time for adoption of Human-centered Design in Health IT. Lives are at risk!

Just another day in the Matrix...

05/16/2019

CMS Releases Final Rule for the 2019 Quality Payment Program | Healthcare Usability

The Centers for Medicare and Medicaid Services (CMS) issued its policies for Year 3 (2019) of the Quality Payment Program via the Medicare Physician Fee Schedule (PFS) Final Rule. The provisions in the rule build on the foundation established in the first two years of the program, and are reflective...

07/13/2018

Our CXO, Bennett Lauber was recently featured on "The Tech Show"

06/20/2018

There is a common set of issues seen in many of the ONC Safety-Enhanced Design evaluations we’ve conducted associated w/the “clinical information reconciliation” tasks.

We are looking for a co-sponsor for a Design Challenge to find solutions to these issues.

04/21/2018

An understanding of the User-centered Design (UCD) paradigm is essential for a successful software project. The most important thing for User eXperience (UX) designers to know is to "know their users."

What are THEIR needs, goals, experiences, etc. What words to THEY use to describe these tasks. Then, once you have an understanding of the tasks and workflow that THEY are likely to use, then you can begin to design a system that matches THEIR mental model and task workflow system.

This will make the system much easier to learn and use, because they will be able to "assimilate" their existing understanding of the tasks into the system you are designing.

Not doing UCD forces them to "accommodate" your workflow, nomenclature, etc. into their tasks --This exactly how to create a steep learning curve for your system, force higher development costs, higher training costs, higher support costs, and have unhappy users.

We have a plethora of additional UX thought leadership posted at: www.TheUsabilityPeople.com/thoughtleadership