In My Mother’s Memory: The Usability of Digital Health Solutions

She died on a Tuesday. While my mother’s passing this summer was expected given her illness, I was still unprepared for the range of emotions that I have experienced.  Tuesday will never be the same.

As the oldest child and the family member most comfortable speaking in front of a crowd, I was asked to prepare and deliver my mother’s eulogy.  I found the main theme for this tribute in the words of Maria Shriver, a former First Lady of California and an American journalist:

Our mothers give us so many gifts. They give us the precious gift of life, of course, but they also leave treasured lessons that can guide us along our journeys even when they are no longer with us.”

My mother left me with many treasured lessons.  Her observations on nursing and the use of digital health solutions have shaped my views and influenced my digital health advocacy work.

My mother was a dedicated and caring nurse for whom nursing was as much a calling as it was a career.   She always referred to the people to whom she provided care as “her” patients.  Whenever we spoke about digital health solutions, she reminded me, often in subtle ways, to consider the needs of the people who use these solutions.

Although my mother was, at best, a computer novice, she saw the value in digitizing healthcare.  She bemoaned, however, what she referred to as the “well meaning” attempts to digitize the world in which she worked.  She often remarked that it was as if the people developing these systems “never walked the floor.”

Even though my mother retired nearly a decade ago, recent feedback from healthcare professionals regarding digital health solutions echoes my mother’s sentiments.

Earlier this year I worked with AmericanEHR Partners to analyze data from the annual AmericanEHR Survey on Physician Use of EHR Systems.  Among the various topics explored in this survey were respondents’ views regarding the ease of use of their EHR systems.

When asked whether they were satisfied with the ease of use of their EHR system, just over half (53%) of the survey respondents reported that their EHR system was difficult or very difficult to use.  Slightly more than one-third (35%) reported that their EHR system was easy or very easy to use.

One of the more striking variations in the survey data became apparent when respondents were grouped based on whether they were satisfied with their EHR system.

A significant majority (89%) of those who indicated that they were satisfied or very satisfied with their EHR system also reported that they found their EHR system was easy or very easy to use.

Conversely, for those respondents who indicated that they were dissatisfied with their EHR system, a significant majority (90%) also reported that they found their EHR system was difficult or very difficult to use.

In a New York Times commentary, Robert M. Watcher, author of “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age”, writes:

“Our iPhones and their digital brethren have made computerization look easy, which makes our experience with health care technology doubly disappointing.”

Why do digital solutions like the iPhone or Google’s Gmail have higher user satisfaction ratings than most digital health solutions?  Many experts suggest that an intense focus on usability and user experience is one reason for this difference.

Bennett Lauber, Chief Experience officer for The Usability People, LLC, and an active member of the U.S. Office of the National Coordinator for Health IT (ONC) Policy Committee’s Implementation, Usability, and Safety Workgroup, observes:

“Usability in healthcare can be difficult to achieve … A useable healthcare system must be designed to match the mental models and workflow of its users.  A usable EHR needs to work (effective), work well (efficient), and not cause any unnecessary frustration (satisfying).”

The ONC appears to agree with the need for a greater focus on usability and the use of tools that contribute to it. Their 2014 certification criteria for electronic health record solutions includes a requirement that vendors attest to using user centered design processes as well as report on the results of their usability testing.

Unfortunately, according to a report from the National Center for Human Factors in Healthcare, many of the 50 electronic health record (EHR) solution vendors serving the highest number of healthcare providers did not meet the ONC’s usability requirements.

Using data submitted by the vendors to the ONC as part of the certification process, researchers at the National Center for Human Factors in Healthcare found that 34% of these vendors had not met the ONC certification requirement of stating their user-centered design process.

Perhaps more concerning, 63% of these same vendors used less than the standard of 15 participants during the usability tests of their EHRs while only only 22% used at least 15 participants with clinical backgrounds.  Nearly one in five (17%) vendors used no physician participants and 5% used their own employees when conducting usability testing.

Researchers commented in the report that “the lack of adherence to usability testing may be a major factor contributing to the poor usability experienced by clinicians.”

So, what happens when digital health solutions are as usable and as useful as other digital solutions? When asked by Robert Watcher what the equivalent of the “Jeopardy!” victory would be in healthcare, Eric Brown, lead engineer of the Watson Health team at IBM replied: “It’ll be when we have a technology that physicians suddenly can’t live without.”

How do you rate the usability of the digital health solutions that you use?  Are there solutions that you or your user community can’t live without?  Please share your thoughts by commenting on this blog post.



2 responses to “In My Mother’s Memory: The Usability of Digital Health Solutions

  1. Daniela Lockhard

    Great article Mike! Makes me wonder whether there shouldn’t be a Chief Experience/Usability Officer within technology firms that focuses on achieving stronger client satisfaction.

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