by Sheri Ross, RN, BN, MBA, CPHIMS-Ca
I recently had an interaction, in a social setting, with an individual I had not previously met. After exchanging the typical pleasantries, she inquired about my employment status. I told her where I work and stated that the business develops and maintains physician office system software and supports physicians in its use. She immediately responded with, "Oh, so you are the ones responsible for turning our doctors into armchair physicians!" I asked her to elaborate on her statement and she responded that, before computers became commonplace in a physician's office, the physician would look at you when you had a conversation—and now they only look at their computers.
I had been thinking and reading recently about the concepts of patient-centred and patient-focused design for EMRs, and as I thought about the statements of this individual, it caused me to think more broadly about what patient-centric design could mean and where the attention or thought could be placed when designing a system with the patient in mind.
Increasingly, in primary care settings, the move toward patient-centred care from a technology perspective has been focused on making personal health records and patient portals available to patients so that they can create their own health record, view or schedule medical appointments, access electronic lab results, and perhaps interact electronically with their care providers. These are all worthwhile pursuits in supporting the patient to become more actively engaged in their own care, but my random conversation with an individual whose only involvement in the healthcare system is as a consumer causes me to think that perhaps there is more that can be done with the design of systems and the preparation of users to improve the patient experience.
In the design aspect, attention should be placed on creating a user interface that supports maximum usability by the clinician. As stated by Nusbaum (2011), "a poorly designed EMR can force the physician to spend time on computer-centred tasks, such as screen navigation and data entry, at the expense of time for patient-centred tasks". Screen design that supports the clinician work flow will result in the physician being able to enter information in an increasingly more consistent and predictable manner, which should reduce the amount of attention that needs to be on the computer—and away from the patient. In order to understand the work flow, those individuals responsible for developing the system can observe the clinician in a typical work environment and during a typical patient visit. By understanding the information that is accessed by the physician during the interaction and the usual steps in the care delivery process, and then designing the system to present that information at the correct point in the interaction, this will improve usability and reduce focus on the computer.
Webster (2010) describes context-aware intelligent user interfaces as:
- Adaptive – can learn their users' preferences and adjust accordingly
- Responsive – can anticipate the users' needs in a changing environment
- Proactive – capable of presenting information when required, based on previous actions taken or the process flow being used
- Autonomous – able to act without human intervention
Webster further states that systems with these attributes are examples of intelligent user interfaces: intelligence gained by capturing information and using it in meaningful ways to improve the interaction for the user.
Beyond design, the user can be supported through the training and implementation process, so that their use of the system can be highly efficient. Training that is based on an understanding of the typical work flow will decrease the amount of time it takes to adapt the use of the system—away from a training environment to one of practical use. Online help that is easily accessed and provides useful prompts for the most frequently encountered challenges will also reduce the time needed to adapt to use in a clinical setting.
Many features within EMR programs are designed to reduce the amount of time a clinician spends on capturing and recording the pertinent details of an interaction. Features, such as templates for routine documentation and reminders that prompt follow-up interventions, are examples. Clinicians who are using these features are enthusiastic about the support they provide in increasing efficient use of the overall EMR system. As gains in efficiency are realized, the opportunity to consider how the patient experience could be improved as well grows—for some, it is simply eye-to-eye contact during the interaction.
Sheri Ross, RN, BN, MBA is Clinical Director at MD Practice Software LP, a member of the MD Physician Services Group of companies and a Canadian Medical Association (CMA) subsidiary.
Nusbaum, N. J. (2011), The electronic medical record and patient-centered care, Online Journal of Public Health Informatics, 3 (2).
Webster, C. (2010), Intuitive vs. Intuitable EMRs, EHRs, and Clinical Groupware: Do we need smarter users or smarter user interfaces? EHR Workflow, July 2, 2010, http://j.mp/aU8192.