Today I saw this wonderful usability pyramid come across my Twitter feed:
Usability Pyramid: Functional > efficient > Intuitive* > Beautiful
#Appian15
* http://t.co/W4VyxKxOtS pic.twitter.com/g1WeG7gYqK
— Charles Webster MD (@wareFLO) April 28, 2015
There’s so much we can learn in healthcare from this pyramid. I’m still chewing on whether the pyramid is the right way to display each of these 4 areas, but I love the way that it breaks it out into these 4 categories. Do they build on each other though?
As I look at these 4 categories of usability, I think that healthcare IT and EHR have done a pretty good job at the functional area. I also think that most of the advanced EHR users are able to work quickly in their EHR. In fact, it’s a complaint I often hear from EHR users that the EHR is so powerful that it takes forever to configure it. The experienced users love these extra configuration options.
I think very few EHR and healthcare IT companies have done a great job on the intuitive and beautiful side of usability. Many doctors think they can just pick up an EHR and start using it just like they did their iPad. This just isn’t the case. It requires a mix of configuration and training to make an EHR work effectively for an organization. Should it? I have yet to find an EHR where this isn’t the case.
I’d love to hear where people think various healthcare IT and EHR applications fit on this pyramid. Let’s hear it in the comments.
(My comments are based on use of GE’s Centricity outpatient EHR.)
Functional? Not very, if the function is health care. Drug alerts tell us that birth control pills are contraindicated in women and that triptans are contraindicated for migraine. They are so consistently useless, that we no longer look at them. The new systems to track things like smoking and exercise for MU have taken away the ability to record clinically useful information (exercise: only yes/no, not what they do or how much or what the barriers are). Point of care decision support is minimal and usually based on an outdated guidelines.
Efficient? I won’t bore you with click-counts for simple tasks, but this is a huge problem. Important information and trivia are randomly distributed on a page.
I am a clinical informaticist. I won’t even go into whether or not I agree with the 4 layers and their definitions.
Looking at “functionality”: EMRs overall, are not mature enough to accommodate the sophisticated, clinical nuances of a patients care. As Mr. Elias states, there is a lack meaningful CDS and hence you get alert fatigue. Functionality to support Best Practices within a workflow that mirrors how clinicians think and work is a huge gap. We and our patients would be better served if we get the “functionality” layer right. The others will fall into place.
The other dimension I would add to this would be, “do users love it?”
As we continue to see the “consumerization” of enterprise software, the key to success is the % of people that would recommend the software to a friend or colleague. Most healthcare software is behind on this dimension but I suspect that in the long term we’ll get there.
A couple of points:
1. Drug alerts. This is an all too common complaint, however experience with one bad system does not mean that all EHRs are faulty. Users need to know which systems are failing and which are not. We have no common reporting system for design flaws, much less EHR adverse events.
2. Usability and Functionality. I like what that Chuck’s shown them in this relationship. Good functionality is necessary for usability but functionality alone is not sufficient.
3. Usability. ONC has abandoned usability. Strangely, ONC funded SMART’s usability testing app, which can measure EHR usability using NIST’s standards. If ONC required vendors to show how they do on NIST’s standards, then users would have a useful benchmark. Until we have independent usability testing and reporting usability will be like the weather – everybody talks about it, etc.
Great discussion. One perspective I find interesting is that for pretty much every EHR (there might be a few exceptions), you can find users that love it and users that hate it. To me this is the mark that it’s functional. The ones that love it obviously have figured out how to use it. Of course, if they don’t move beyond the functional stage, then when the next shiny object comes by that can take them to what they perceive as a beautiful state, they’re likely to bolt and switch EHR if possible.
We should dig in a lot more on why an EHR works great for one user and not for others.