Monday, September 12, 2011

Here Are Two Key Issues That The PCEHR Team Seem Not to Be Taking Seriously. The System Won’t Be Used If It Fails on These!


The following appeared a few days ago:

The 5 traits of a usable EMR

September 06, 2011 | Michelle McNickle, Web Content Producer
There are several factors inhibiting EMR adoption, but the concept of usability is often at the root, and rightfully so. Although effective training and implementation methods affect user adoption rates as well, poor usability has a strong impact on productivity, error rate, and user satisfaction.
And usability should be considered more than just user satisfaction, according to Rosemarie Nelson, principal of the MGMA Consulting Group. The concept is far more complex, and to Nelson, it’s synonymous with workflow integration. “Too much attention is given to the number of clicks and screens, when what should be considered is how and when information is presented,” she said.
Dr. Steve Waldren, MD, Director of the American Academy of Family Physicians’ Center for Health IT, explained that when it comes to understanding usability, it’s essential to consider utility as well. “Usability is subjective in many ways,” he said. “It has to do with the functionality of the system. Utility is making sure the system does the things you need it to do.”
So what determines if an EMR is useable? Better yet, how can prospective users ensure a system won’t result in headaches over lost productivity? According to Nelson, the first step is to recognize no system is perfect.
“The problem for most providers is they, nor their vendor implementation team, look for that commonsense template: the one that fits a majority of patient visits, not the ‘perfect’ template that allows visits for all patients to be documented. There is just too much variation to expect 100 percent.”
With that in mind, here are five additional elements to consider when it comes to EMR usability.
1. Supportiveness:
2. Flexibility:
3. Ease of Learning/ Naturalness:
4. Effectiveness:
5. Efficiency:
One thing is for certain when it comes to EMRs and their usability: it’s an evolution that’s essentially controlled by the user. “EMR usability must evolve similarly in that as we try to use it within our day, we can see where improvements can be made,” said Nelson.
The full article is here with the 5 areas expanded and explained:
In a similar related vein when we move to implementation there are some tips:

The 7 Deadly Sins of EMR implementation

By Michelle McNickle, Web Content Producer
Created 09/07/2011
Congratulations! You've committed to an EMR, which is an accomplishment in itself. But the hardest part is still to come: getting it to work.
From failing to plan to skipping out on training, many mistakes can be made during the implementation process. And although they may not be as juicy as wrath, envy or lust, the Seven Deadly Sins of EMR implementation could wreak just as much havoc.
Steve Waldren, MD, director of the American Academy of Family Physicians' Center for Health IT, and Rosemarie Nelson, principal of the MGMA Consulting Group, gave us the worst sins providers can commit during EMR implementation.
1. Not doing your homework
2. Assuming the EMR is a magic bullet:
3. Not including nurses in the planning stages:
4. Not participating in training:
5. Thinking you can implement the same processes as paper:
6. Not asking for extra help
7. Being short sighted:
All the points are expanded here:
There are some highly relevant ideas contained in the details of all this for the PCEHR. Utility and accessibility will be just crucial. Having to access a portal on a separate tab all the time just won’t cut it!
In the context of the newly released PCEHR ConOps for example note the sample screen for the consolidated view of the PCEHR. The number of clicks / key strokes to access the contents looks to be enormous. See the picture on Page 58 (a mockup of the view) to note the absence of an ‘expand all function’ and the 11 different buttons which may need to be looked under!
Someone needs to remind the NEHTA geniuses that the GPs and specialists will be using their systems day in and out - while most patients might use it once a month. The design simply fails to grasp that fact.
Both usability and carefully planned implementation are critical for success.
I hope they are all reading closely.
David.

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