Farzad Mostashari, M.D., HHS National Coordinator for HIT opening the NIST Workshop “Creating Usable EHRs” addressed the need to look in-depth at usability issues. Usability represents an important yet often overlooked factor impacting the adoption of EHR systems.
Without usable systems, doctors, medical technicians, nurses, administrative staff, consumers, and other users can’t benefit from the potential benefits of the features and functions of EHR systems. ONC is collaborating closely with NIST and other agencies to develop health IT usability standards and measurements and want to see a common sense approach to usability issues discussed.
As Dr. Mostashari, explained, very often designers and vendors do not go into depth or have discussions with the buyer on the issue of usability before the system is purchased. Most people buy equipment only after seeing a slick demo on the product and therefore don’t have enough information on what they have just purchased.
In many cases, the seller very often has more information than the provider buying the product. In addition, when companies purchase the larger systems, usually the Chief Medical Officer doesn’t necessarily pick the product since the final decision is usually up to the Chief Financial Officer.
To pinpoint the need for more usable EHR systems, David Brick M.D a pediatric cardiologist discussed the usability factors needed by the specialized pediatric population and their doctors. Dr Brick pointed out that the information in an EHR used for pediatric cardiac patients very often differs greatly from the information needed for adult care.
As he explained, pediatricians have to deal not only with pediatric care versus adult care, but they also they treat the fetus, neonates, and adolescents, along with their usual pediatric patients. They often see all of these categories of patients in one day and not always only in their offices. They have to be in touch with urgent care facilities, emergency rooms, ICUs, and operating rooms. This further necessitates the need for accurate medical data to be available through a reliable EMR system that can provide data in every medical situation.
He discussed in detail how the growth chart in an EMR is such a critical component for any pediatric chart so that medication overdoses do not occur. An average baby can weigh from nine to twelve pounds at birth while the average length of an infant is usually about eighteen inches.
As Dr. Brick noted, there can be considerable differences in just the matter of weight changing with newborns. During the first week of life newborns can lose weight but the length does not usually change during that week. However, the newborn’s change in weight during the first week can greatly affect dosing issues. Therefore, information from the growth chart needs to be accurately documented and easily available in the medical record.
To address usability issues, NIST published the report “Human Factors Guidance to Prevent Health Care Disparities with the Adoption of EHRs” (NISTIR 7769). To view the report, go to www.nist.gov/customcf/get-pdf.cfm?pub_id=907991.
