USER CENTERED DESIGN... Usability and User Centered Design • Extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and

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Realizing the potential of improving care and continuous learning: USER CENTERED DESIGN

LEADERSHIP CONSORTIUM FOR A VALUE & SCIENCE-DRIVEN HEALTH SYSTEM Digital Learning Collaborative, National Academy of Medicine: December 1, 2016

Rollin J. (Terry) Fairbanks, MD, MS Director, National Center for Human Factors Engineering in Healthcare

Associate Director, MedStar Institute for Innovation MedStar Health, Washington DC, USA

Associate Professor of Emergency Medicine, Georgetown University Attending Emergency Physician, MedStar Washington Hospital Center

@TerryFairbanks

www.MedicalHumanFactors.net

What is Human Factors Engineering?

…discovers and applies scientific data about human

behavior & cognition,

abilities & limitations,

physical traits,

and other characteristics

…to the design of

tools & machines,

systems,

environments,

processes,

and jobs

for productive, safe, comfortable, and effective human use.

--Sarah Henrickson Parker, PhD


Human Factors Engineering

“We don’t redesign humans; We redesign the system within which humans work”


The Two Bins of Usability


1: User Interface Design Context Independent

Displays and Controls

Screen Design Clicks & Drags

Colors & Navigation

The Two Bins of Usability

2: Cognitive Task Support

Context Dependent

“Workflow Design” Smart Data Visualization Support Cognitive Work

Functionality

Photo credit to Bob Wears, MD, PhD

www.MedicalHumanFactors.net http://www.himss.org/ValueSuite Photo credit to Bob Wears, MD, PhD

Bin 1 –User Interface (UI)



1

Bin 2- basic

1


Bin 2 - Basic

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Bin 2 – Advanced





Usability and User Centered Design • Extent to which a product can be used by specified users to

achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use

• Usability is measurable

• User centered design is a process for developing usable systems

ISO 3407

Understand and specify the

context of use

Specify the user and organizational

requirements

Produce design solutions

Evaluate design against

requirements


What user-centered design is NOT

• Simply having physician/nurse on design team

• Advisory Board

• Focus Groups

• Isolated, late stage summative testing

• Guidance for training design


EHR Vendor UCD Processes

•Focused on customer requests

•Responding to user feedback is UCD

•No formalized method for incorporating and testing user needs throughout design and development

No True UCD

•Understand UCD and its importance

•Striving to implement UCD processes

•UCD is not fully integrated yet

Basic UCD

•Rigorous UCD processes in place

•Efficient testing methods

•Extensive infrastructure

Well Developed UCD

Challenges: • Context and exposure • General process • Support

Challenges: • Resources • Participant access • Use case development

Challenges: • Detailed work flow analysis • Safety data

Ratwani RM, Fairbanks RJ, Hettinger AZ, Benda N. Electronic Health Record Usability: Analysis of the User Centered Design Processes of Eleven Electronic Health Record Vendors. Journal of the American Medical Informatics Association. 2015


MedStar/AMA Usability Framework

• Many use cases lack rigor

• Metrics are inconsistent

• Risks identified through testing are rarely described

www.healthITusability.org Ratwani, R. M., Hettinger, A. Z., Kosydar, A., Fairbanks, R. J., & Hodgkins, M. L. (2016). A framework for evaluating electronic health record vendor user-centered design and usability testing processes. Journal of the American Medical Informatics Association, ocw092.


What Will It Take? Collaboration

• Vendors: Cerner, Allscripts, athena, EHRA, etc

• Associations: AMA, ACP

• Advocacy: Pew

• Providers: CHOP, University of Florida, Christiana, Baylor Scott & White, UNC,

• Government Agencies: AHRQ, ONC, FDA, NIST

• Universities: Virginia Tech, Univ. at Buffalo, Georgetown, George Mason


Acknowledgments Raj Ratwani, PhD Zach Hettinger, MD MS Natalie Benda, MS Scientific Director Medical Director Research Fellow Cognitive Psychologist Informaticist & Physician Human Factors Engineer

Our Health IT work has been supported by: NIH (NIBIB), AHRQ ,ONC, DoD, AMA, RTI, Pew, Emergency Medicine Patient Safety Foundation, and Latham Foundation.

[email protected] Twitter: @TerryFairbanks

mailto:[email protected]

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USER CENTERED DESIGN... Usability and User Centered Design • Extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and