The assessment of software’s usability is gaining recognition in the field of healthcare nowadays. The chief reason for this is the ongoing transition to electronic health records (EHR) or, to be more exactly, its constant shortfalls (Middleton et al., 2013). While expected to bring major improvements to the field and eliminate long-standing issues, the adoption of EHR software has been associated with increased financial burden without predicted improvements (Middleton et al., 2013). The most often cited reasons for this are the poor usability of adopted software and the lack of proper usability testing procedures prior to technology implementation (Middleton et al., 2013). The following paper attempts to illustrate the importance of usability assessment of the EHR software by using the example of Allsripts Sunrise clinical platform. The assessment locates usability issues by observing a user performing a set of tasks and provides evidence-based recommendations to improve the identified issues.
Allscripts Sunrise Background
Allscripts Sunrise is an enterprise-scale clinical platform which incorporates several modules, including an integrated EHR connectivity, computerized physician order entry (CPOE) functionality, clinician decision support platform, and medication management module, among others (Allscripts, 2016). Its main purpose can be broadly described as assistance in coordination of clinical activities within a department as well as across the establishment, automatized improvement of safety and accuracy of operations, support to decision-making process of clinicians, and, by extension, improve overall performance of the establishment and patient outcomes.
The software is not specialty-specific and can be scaled to the needs of hospitals of various magnitude. The software is known for its constant update based on the process known as user-centered design (UCD), which ensures that the software functionality is aligned with the needs and expectations of customers. The current version of the software is available for approximately half a year, with previous version (featuring no major differences from the current version) being available for roughly a year. This brings total time of student familiarity with the software to almost one year and a half.
Method of Assessment
A framework suggested by Lowry et al. (2012) was used to assess usability of the software. This method was used since the identified difficulties in usability are largely similar across software solutions and, therefore, were not expected to differ in our case (Middleton et al., 2013). The assessment was in the form of three tasks, each targeting specific area of the platform’s functionality (retrieving patient information, obtaining lab results, and prescribing appropriate medication). Each task was assessed based on two criteria – the overall success of completion, and the comparison of the actual path taken by the student versus the intended path recommended by the software provider. After the completion of three tasks, an additional set of questions was presented to the students aimed at locating the identified positive and negative aspects of experience.
The observation revealed several issues to the system. The most prominent was the deviation from the path taken to complete the task. On two occasions, students were unable to move to the next screen in the predicted order and in one instance a student chose the wrong button, although she instantly corrected the error. Importantly, the described deviations did not result in significant time loss (twenty-six versus twenty-eight seconds on the average). However, both results were significantly higher than the desired result of twenty-two seconds stated by the provider (Teague, 2016). Finally, on four occasions the platform was characterized as “sophisticated” which, while not a strictly negative characteristic, suggests unnecessary complexity.
Evidence-Based Recommendations
The identified issues in usability illustrate a potential impact on the efficiency of the adopted software solutions. It is important to acknowledge that while the inquiry did not produce evidence of adverse effects of the mentioned issues, they are expected to emerge on a broader scale. For instance, the issue of following the wrong path of operation and choosing a wrong option in switching screens can be addressed in two ways. First, involvement of clinicians is expected to improve understanding of software vendors about the desired changes and the existing problems. While such channels already exist, they do not guarantee timely interventions and often result in late acquisition of necessary feedback. Second, the issue can be tackled at organizational level – specifically, the impact of usability on the effectiveness of outcomes must be communicated to establishment’s management (Middleton et al., 2013). This approach would ensure two-way nature of collaboration and improve the chances of successful adjustment.
The perceived sophistication of software can also be addressed from both sides. Health care establishments need to increase end user familiarity with the chosen software by developing training sessions and complementing them with progress evaluation to ensure the success (Meehan et al., 2016). The developer should work on decreasing visual complexity of the platform to improve perception and accessibility (Payne et al., 2015).
Conclusion
The overall assessment of Allscripts Sunrise produced favorable results. All of the identified issues were minor and did not lead to serious workflow disruption. The below-average result suggests the lack of experience as one potential cause of under-performance. However, the suggested improvements are expected to further minimize undesirable usability issues and prevent the emergence of new ones in the future.
References
Allscripts. (2016). Sunrise. Web.
Lowry, S. Z., Quinn, M. T., Ramaiah, M., Schumacher, R. M., Patterson, E. S., North, R.,…& Abbott, P. (2012). Technical evaluation, testing, and validation of the usability of electronic health records. Web.
Meehan, R. A., Mon, D. T., Kelly, K. M., Rocca, M., Dickinson, G., Ritter, J., & Johnson, C. M. (2016). Increasing EHR system usability through standards: Conformance criteria in the HL7 EHR-system functional model. Journal of Biomedical Informatics, 63(2), 169-173.
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage, J. M.,…& Zhang, J. (2013). Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. Journal of the American Medical Informatics Association, 20(1), 2-8.
Payne, T. H., Hines, L. E., Chan, R. C., Hartman, S., Kapusnik-Uner, J., Russ, A. L.,…& Glassman, P. A. (2015). Recommendations to improve the usability of drug-drug interaction clinical decision support alerts. Journal of the American Medical Informatics Association, 22(6), 1243-1250.
Teague, R. (2016). Improving EHR usability with user-centered design. Web.