It's an exciting time for the health IT community: the wider use of electronic health records (EHRs), coupled by new integrated delivery models, clinical support systems, and mobile technology provides an amazing opportunity to dramatically improve care delivery while changing how patients and providers interact.

Unfortunately, this rapid change has wreaked a bit of havoc on health IT providers. Over the past few years, vendors have been consumed by EHR certification and support for Meaningful Use while continuing their own feature development. However, this rapid rollout of EHRs has laid a solid foundation from which we can build.

Now, I believe we need to turn our focus from critical internal development — the plumbing — to the user experience. As our healthcare system moves away from an ad hoc, fee-for-service system and towards an integrated care model, we must design and create health IT solutions that will enable and empower users — from patients to providers.

It's well-documented that health IT systems have historically been designed for documenting clinical transactions, not for supporting healthcare professionals in their care settings. This is now changing as EHRs become embedded in clinical care, generating recognition of the importance of usability. Both the Institute of Medicine (IOM) and the American Medical Informatics Association (AMIA) have recommended more research into usability and the effect on health IT, ranging from human factors, safety, and culture.

This is a start but we should look beyond just making health IT systems simpler. In my experience, addressing usability often focuses narrowly on ease of use — examining how we make systems or products look and feel simpler for people to use. To be sure, this is an important part of the overall solution, but a myopic focus on strict simplicity loses sight of the true potential of a system. In an ideal user experience, simple things remain simple while more complex tasks are still possible. Further, as we make improvements in current health IT interfaces to enable interactions from simple to complex, we need to consider the user’s background and training as we will encounter varied skill levels.

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We should not assume that making things easy to use is an absolute. Instead, I believe we need to think about usability as a marriage of technology, design, frequency of use and training that amplifies human potential. Learning to ride a bike or play a violin are awful early experiences, full of scraped knees and eardrum-breaking screeches. Both can be difficult to learn and fail the ease of use test miserably. But these amazing devices serve as incredible amplifiers of human potential — once some skill is acquired. And importantly, the amplification increases with training and practice. This is why so many put up with the difficult task of learning to use these devices — we know our efforts will be rewarded.

Let’s look at a more modern example: video games. Most video games require little effort to get started, but as you progress, they require additional knowledge, often through hours of playing, practice, or training. If you want to get to the highest level, you need to learn and use new tools, and in the case of multi-player games, collaborate and cooperate with a team.

This is what we need to consider when designing health IT systems — usability principles and standards that seek to amplify human potential. I'm afraid that the power that these technologies afford, helping providers make critical decisions for their patients and engage and integrate them into the care process, will be stripped away in a rush towards strict simplicity.

Truly effective user experience remains vital to the future success of our integrated healthcare system. We must look at the complete user experience, however, and not sacrifice power for ease of use. If we strike the right balance between function and performance with usability, we can meet the future health IT needs and match the skills of the user from beginner to expert, consumer to clinician.

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