A lot has been said about usability, whether it’s in regard to EHRs or other healthcare apps. We asked Shahid Shah, software IT analyst and author of the blog The Healthcare IT Guy, to debunk some of the myths and explain some of the realities of health IT usability. 

1. Myth: The slow adoption of EHRs and other health IT apps has been due to usability issues.

Reality: Systems have low adoption when they have little or no value to those conducting data entry, said Shah. According to him, a system has real value when it completes what he calls the PBU (payer, benefiter, user) circle. “Every system has a payer, or the entity that buys the system,” he said. “But [he/she] doesn’t necessarily interact with it. [The system] also has one or more users and one or more benefiters, or those who gain the most value from the system. Many EHRs and other apps are not designed for all three members of this circle.” 

 2. Myth: Health IT usability is an application or software issue that engineers need to resolve.

Reality: “Usability only partially depends on software,” said Shah. According to him, many systems are deemed “usable” in a test lab, but they “fall prey to usability problems quickly in a live production setting because usability is often an emergent property of an entire closed or open system.” What drives usability, he said, is complex multi-user workflows, collaborative timing and handoff requirements, security policy, physical spaces, numbers of computers per staff and other non-software issues.

[See also: EHR ballot is a "yes".]

3. Myth: The primary goal of EHR and health IT usabilty is to make systems easier to use, implement and adopt.

Reality: The goal of usability, said Shah, is to allow safe and secure operation that ultimately creates systems that improve patient outcomes and reduce operating costs. “Once you’ve focused on patient safety and privacy, then worry about ease of use, ease of implementation, and system adoption,” he said. “A system that can be quickly adopted and easy to use, while allowing unsafe operation, will be thrown out quickly.”

 4. Myth: Making data entry screens easier to use makes systems more usable.

Reality: “Absolutely wrong,” said Shah. “Eliminating data entry screens makes systems more usable.” If you’re focusing your design or engineering efforts on tasks that improve data entry but don’t focus on eliminating data entry by connecting to medical devices or integrating with other systems, then you won’t have a usable system, he said. “Instead of making slick screens that allow faster creation of patients, focus on how to do real-time integration with other systems that might already have the patient registration already created."

[See also: EHR adoption an "ugly process," but CCHIT can improve appeal.]

5. Myth: EHRs and other health apps should eliminate features, remove capabilities and simplify screens to make them easy to use.

Reality: Not at all, said Shah. In fact, he suggests embracing the complexity and focusing on making systems easy to train on, well-documented, easy to support and easily and remotely serviced. “Add detailed instrumentation into each of your screens, workflow steps and function points, so you can understand which capabilities are used by what user groups,” he said. “You can get by with removing features and functions early on, but then you’ll have to add them [based] on user demand in a haphazard manner in the future.”

6. Myth: Studying the current analog paper-based workflow, and digitally duplicating it with structured forms, will create a usable system.

Reality: “Nonsense. Paper is cheap, ubiquitous, instantly usable, and supports infinitely flexible workflows – digital systems require input devices and devices have to be carefully managed, shared and configured for specific, fixed, workflows,” said Shah. According to him, the more you mimic a paper-based workflow with structured forms, the less likely you’ll have a usable system that can eventually adapt to other digital workflows in the future. “Usability doesn’t mean giving your users everything they ask for,” he said. “In fact, if you give them what they want when the only workflows they know are paper-based, then you won’t be able to let them easily improve their workflows once they learn your system.”

Follow Michelle McNickle on Twitter, @Michelle_writes