You might say it started when my office bought its first thermal paper fax machine. In my early practice days we had two offices and we invested in the fax machine so we could fax records between offices. We immediately realized the benefits of being able to access patients' records from either office and quickly upgraded to a plain paper fax machines as the "usability" of paper vs. thermal paper became obvious!
In the late 1990’s I was the Medical Director of a healthcare delivery organization and was working with IT staff to develop reports. They knew how to run reports but they did not know what questions to answer. I was also enrolled in an executive MBA program studying organizations and how the most successful organizations effectively align people, process, and technology. It was obvious that computerized medicine (the term healthcare IT was not in vogue yet) was coming; that computers would transform healthcare, and that clinicians needed to play a major role in shaping the introduction of technology into the clinical space. I wanted to be part of that transformation and my informatics career began.
My perspective on usability
My HIT perspective comes from my broad experience working for larger vendors and system integrators (McKesson, Siemens, CSC) and directly with customers in a variety of roles including: Clinical Analyst, Product Manager (including running a medical informatics user group), Consultant, and Advisory CMIO. Vendors have many challenges – delivering desired feature functions, simplifying implementations, guiding customers, and optimizing systems all while meeting government mandates and competing to win business. Usability was an ongoing concern. Clinicians wanted systems that were safe, easy to use, and something that did not slow them down. They still do. Unfortunately, technical limitations and constraints, legacy build decisions and costs can be impediments to optimizing usability. The majority of today’s systems share similar usability issues. I also learned that technical architecture decisions made years ago (for example the early focus on episodes of care to support revenue cycle) and “coding to meet regulations” have durable impacts.
Some lessons related to usability
Usability must be improved industry-wide but it won’t happen overnight. It will be an evolution that takes time and will require new technologies and approaches to system design. My concern is that regulatory mandates and associated costs that impact development plans and costs will detract from innovation.
Today, from a practical standpoint, usability starts with implementation. This includes configuration, system content and process optimization and training. Many usability complaints can be addressed to some degree using available configuration tools (user security settings, defaults, screen layout…) Organization never get it perfect the first time - ongoing optimization is always required and this takes resources and organizational commitment.
Optimal usability means different things to different users. Clinician tolerance and usability preferences vary between individuals and specialties and experience using a system. The most vocal users are not always right.
Partner with your vendor as much as you can while holding them accountable. Yes, vendors are people too and go to great lengths to deliver the safest and most usable system they can. Effective engagement with your vendor impacts prioritization of development and enhancements. Participate in user groups and other opportunities to voice your concerns.
Advice to physicians interested in informatics
As a baseline, I recommend taking advantage of educational programs and resources from HIMSS as well as other meeting and networking opportunities also available through many medical specialties, AMDIS and AMIA. Beyond that, there are 3 general paths into informatics, depending on your interests and situation:
- First, be a clinician champion and grow into the role by participating in your local organizations HIT implementations, optimizations and governance. This is low risk and can be done while still actively engaged in clinical practice.
- Second, work for a HIT vendor and grow into the field through experience. The advantage of this is your learning and exposure to HIT can be greatly accelerated and you get broad exposure to many aspects of HIT and real-life HIT application. You also can draw on vendor’s deep technical expertise.
- Third, get formal medical informatics training or and advanced business degree. The requirement for formal certification is increasing for some positions. Regardless of your path, the first step is to gain applied HIT experience and exposure that establish basic credentials and demonstrate a commitment to the field.