Designing Usable Healthcare Applications
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Guide walking through the design of a healthcare application, with focus on an Electronic Medical Record system.
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Designing Usable Healthcare Applications
- 1. Designing Usable Healthcare Applications: From Theory to Reality Jon Duke, MD, MS November 21st, 2013
- 2. The Need for Innovation in EMR Design • The required or expected functionality of EMRs is increasing • Concerns over usability have been longstanding and will be exacerbated as functionality grows more complex
- 3. We’ll Get to This Stuff
- 4. But Let’s Start Here
- 5. Strategies for Achieving This Balance • Leverage Metaphors • Constrain Then Innovate • Set Gravity in the Right Direction
- 11. Workflow Wizard • Goal was to support multiple workflows for each user type based on – Role (e.g., MD, RN, Dietitian) – Training Level (e.g., Attending, Resident, Student) – Specific Permissions • Creates a Wizard-like guide for each
- 12. Workflow Wizards
- 13. E-Commerce
- 14. Batch Operations
- 16. FAIL
- 19. Screen Real Estate • At outset of development process, set aside an untouchable area of screen real estate • Area was envisioned for a variety of information needs but was not instantiated for > 1 year
- 20. Order Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety DSS / Stream
- 23. Concurrent Access • Our previous system did not allow multiple users performing actions on the chart simultaneously • Sought to allow this behavior while maintaining patient safety and avoiding database conflicts
- 27. Set Gravity in the Right Direction
- 30. Allergy Entry
- 31. Fitt’s Law
- 32. Fields on Demand
- 33. Fields on Demand
- 34. Design Strategies • Leverage Metaphors • Constrain Then Innovate • Set Gravity in the Right Direction
- 35. Demo
- 36. Overview • Overview of Application Design Process • From Theory to Reality: Designing the G3 Physician Order Entry System • Challenges and Lessons Learned • Discussion
- 37. Iterative Design Overview Design, Conceptual & Physical User Requirements Models & Specifications Evaluation & Feedback Prototyping & Construction Demos & Products
- 38. Establish Requirements • Functional Requirements • Usability Requirements • User Experience Goals
- 39. Establish Requirements • Functional Requirements • Usability Requirements – Efficiency – Learnability – Memorability – Safety (error avoidance) – Utility (usefulness) • User Experience Goals
- 40. Establish Requirements • Functional Requirements • Usability Requirements • User Experience Goals – Satisfying – Reliable – Trustworthy – Enjoyable – Motivating – Helpful
- 41. Requirements Gathering • • • • Ethnographic Observation Interviews with Clinicians Review of Existing Systems Health IT Domain Experts
- 42. Conceptual Design • Conceptual Model – a description of the proposed system in terms of a set of integrated ideas and concepts about what it should do, behave, and look like – Includes artifacts, relationships, workflows – Seek to communicate and match developer’s mental model to user’s mental model
- 43. Conceptualizing the Interface • Interface Metaphor – Combine familiar concepts and representations, leverage existing ideas and known solutions • Interface Mode – – – – Instructing Conversing Manipulating Exploring • Interface Paradigm – Desktop, mobile, wearable, ubiquitous, etc
- 45. User Centered Design Methods • Personas – hypothetical archetypes of real people – derived from field research on users • Scenarios – fictional story describing a user’s interaction with the application to achieve one or more goals – Incorporates personas and their environment • Use Cases – Generic description of action-response functionality of a system, does not incorporate particulars of a user
- 46. Prototyping • Low Fidelity – Purposely non-realistic, encourages ideas and rapid iteration • High Fidelity – Increased similarity to final product – Provides better sense of the user experience
- 47. Usability Testing • From prototypes to early stage development • Test early, Test often – 3-5 users sufficient • Cognitive Walkthrough – Scenarios / Task Analysis – Think-aloud – Interviews
- 48. Heuristic Evaluation • Evaluate system’s adherence to accepted usability principles (‘heuristics’) • Examples – Recognition over Recall – Forgiveness – Feedback – Consistency – Simplicity
- 49. Iterate! Design, Conceptual & Physical User Requirements Models & Specifications Evaluation & Feedback Prototyping & Construction Demos & Products
- 50. Theory to Reality • Regenstrief has maintained a CPOE at Wishard Hospital for >30 years
- 51. Updating a Classic • The Gopher system has been used by thousands of physicians • Its developers iterated on the system for decades, enhancing its functionality, usability, and speed • Gopher-based research provided much of the seminal knowledge on CPOE and CDS • While beloved, DOS-based Gopher is headed for retirement at the end of 2011
- 52. Welcome to G3! G3 UI Design- May 2010
- 53. G3 Requirements • Formal Requirements • Functional, Usability, and User Experience Goals • Workflow
- 54. Initial Conceptual Design for Ordering • Interface Metaphors – e-Commerce / “Order Cart” – Web-style Navigation for workflow – Streams (a la Twitter) for additional information • Interface Type – Instructing • Interface Paradigm – Desktop – Do not rule out mobile
- 56. Order N A V I G A T I O N Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety DSS / Stream
- 57. Order Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 58. Order Si Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 59. Order Si Medications Simvastatin ----------------------------------------------------------Sibutramine Sildenafil Silodosin Simethicone Silver Sulfadiazine Simvastatin Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 60. Order Simvastatin Medication Strength Instructions Quantity Refills Indication Medications Simvastatin 20mg qpm with food Hyperlipidemia Add to Cart Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 61. Order Simvastatin Medication Strength Instructions Quantity Refills Simvastatin 40mg qpm with food #60 2 Indication Hyperlipidemia Add to Cart Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 62. Medications Order Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Simvastatin 40mg qpm with food #60 2 refills Sign Orders
- 63. Order Lisinopril Medications Medication Strength Instructions Quantity Refills Lisinopril 10mg 1 tab daily QS 2 months Indication Hypertension Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg 2 Add to Cart Simvastatin 40mg qpm with food #60 2 refills Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Sign Orders
- 64. Order Lisinopril Medications Medication Strength Instructions Quantity Refills Lisinopril 10mg 1 tab daily QS 2 months Indication CHF Hypertension Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg 2 Add to Cart Simvastatin 40mg qpm with food #60 2 refills Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Sign Orders
- 65. Medications Order Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Simvastatin 40mg qpm with food #60 2 refills Lisinopril 10mg daily QS 2 months 2 refills Sign Orders
- 66. Order TSH Medications Thyroid Stimulating Hormone (TSH) Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Simvastatin 40mg qpm with food #60 2 refills Lisinopril 10mg daily QS 2 months 2 refills Sign Orders
- 67. Order Thyroid Stimulating Hormone (TSH) Lab Name Start Time Comments Indication TSH Today Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Simvastatin 40mg qpm with food #60 2 refills Lisinopril 10mg daily QS 2 months 2 refills Sign Orders
- 68. Order TSH Lab Name Start Time Comments Indication Medications TSH Today Hyper Hyperlipidemia Hypertension -------------------Hypercalcemia Hyperesthesia Hyperlipidemia Hyperkalemia Hypernatremia Simvastatin 40mg qpm with food #60 2 refills Lisinopril 10mg daily QS 2 months 2 refills Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Sign Orders
- 69. Order TSH Lab Name Start Time Comments Indication Medications TSH Today Hyperthy Hyperthyroidism Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Simvastatin 40mg qpm with food #60 2 refills Lisinopril 10mg daily QS 2 months 2 refills Sign Orders
- 70. Order TSH Lab Name Start Time Comments Indication Medications TSH Today Hyperthyroidism Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Add to Cart Simvastatin 40mg qpm with food #60 2 refills Lisinopril 10mg daily QS 2 months 2 refills Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Sign Orders
- 71. Medications Order Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Simvastatin 40mg qpm with food #60 2 refills Lisinopril 10mg daily QS 2 months 2 refills TSH Draw Today Sign Orders
- 72. Order Simvastatin 40mg qpm with food #60 2 refills Lisinopril 10mg daily QS 2 months 2 refills TSH Draw Today Hyperthyroidism Password Logout No Sign Orders
- 73. Medications Order Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Batch Renewal v1 Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Lisinopril 10mg daily QS 2 months 2 refills Simvastatin 50mg daily QS 2 months 2 refills HCTZ 25mg daily QS 2 months 2 refills Sertraline 10mg daily QS 2 months 2 refills
- 74. Medications Order Batch Renewal v2 Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Lisinopril 10mg daily QS 2 months 2 refills Simvastatin 50mg daily QS 2 months 2 refills HCTZ 25mg daily QS 2 months 2 refills Sertraline 10mg daily QS 2 months 2 refills
- 75. Medications Order Medications Lisinopril 10mg Batch Renewal v3 Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 76. Medications Order Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Lisinopril 10mg daily QS 2 months 2 refills Simvastatin 50mg daily QS 2 months 2 refills HCTZ 25mg daily QS 2 months 2 refills Sertraline 10mg daily QS 2 months 2 refills Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 77. Medications Order Batch Renewal Keyboard (Ctrl+R) 1 2 3 4 5 6 7 Lisinopril 10mg Lisinopril 10mg Simvastatin 20mg Simvastatin 20mg Advair 250/50 HCTZ 25mg HCTZ 25mg Ambien 10mg Sertraline 100mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Lisinopril 10mg daily QS 2 months 2 refills Simvastatin 50mg daily QS 2 months 2 refills HCTZ 25mg daily QS 2 months 2 refills Sertraline 10mg daily QS 2 months 2 refills
- 78. Order Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Drug Information Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety Lisinopril 10mg Daily First Rx: 9/2/95 Last Refill: 5/1/10 Compliance: Fair
- 79. Order N A V I G A T I O N Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 80. Order Medications Lisinopril 10mg Simvastatin 20mg Advair 250/50 HCTZ 25mg Ambien 10mg Sertraline 100mg Wellbutrin 150mg Problems Hypertension Hyperlipidemia COPD CHF Insomnia Depression Anxiety
- 81. Usability Testing • Cognitive walkthroughs – Physicians in clinic – Residents in hospital – Rotating students • Heuristic Evaluation – HCI domain experts – Clinical informatics experts
- 82. Iterative Development • Improved core functionality • Removed non-core Functionality • Refined Usability – Speed – Feedback – Status – Language
- 83. Where have we gone? • 2010 Demo
- 84. Where Are We Today?
- 85. Where Are We Today?
- 86. Where Are We Today?
- 87. Where Are We Today?
- 88. Where Are We Today?
- 89. Where Are We Today?
- 90. Where Are We Today?
- 91. Where Are We Today?
- 92. Top Development Challenges • • • • Time Complexity / Scope Prioritization Core Development vs Responsiveness to User Needs • Team Management • Multiple Stakeholders
- 93. Lessons Learned • Define requirements clearly up front • Generate detailed specifications • Gives developers ownership of tasks and sense of impact of project • Respect roles and process • Test with users frequently, iterate based on evidence, avoid capricious changes
- 94. Lessons Learned • • • • • • Simple things can be very hard Brilliant things can be very easy Don’t lose the forest for the trees Grow small Embrace your failures Innovation matters, whatever they say
- 95. What Are Your Projects?
Editor's Notes
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- In G3,
- ? Leave this out?
- Strength and Indication are pre-filled in from prior, want to show what is a lab
- Strength and Indication are pre-filled in from prior
- Need to be able to expand cart, show more, etc
- Need to be able to expand cart, show more, etc
- Servicevs research