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Initial Steps and Progress Toward a Healthcare Usability Maturity Model

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Initial Steps and Progress Toward a Healthcare Usability Maturity Model 1 Promoting Usability in Health Organizations: Initial Steps and Progress Toward a Healthcare Usability Maturity Model HIMSS Health IT User Experience Committee ©2015 Healthcare Information and Management Systems Society. 2 Table of Contents Executive Summary 5 Introduction 8 Defining Usability and the User Experience Purpose of the Document Incorporating Usability into Health Organizations 9 Background: Historical Perspective of Usability The Value of Usability to Healthcare Projects 12 Increased Individual Effectiveness and Efficiency Increased Organizational Efficiencies Toward a Health Usability Maturity Model: A Review of Current Usability Maturity Models 17 Schaffer Usability Maturity Model Nielsen Corporate Usability Maturity Stages Earthy Human Centeredness Model Model Comparisons Health Usability Maturity Model 26 Phase 1 ‐ Unrecognized Phase 2 ‐ Preliminary Phase 3 ‐ Implemented Phase 4 ‐ Integrated Phase 5 ‐ Strategic Initial Steps for Incorporating Usability into Health Organizations 35 Specific Tactics to Expand Usability in Organizations Usability Case Studies 38 U.S Department of Defense Baylor Health Care Systems, Dallas University Health Network, Toronto Recent National Documents on Usability 40 Usability Web sites and Resources 41 ©2015 Healthcare Information and Management Systems Society. 3 Appendix A: 42 • Summaries of National Documents on Usability • NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Record • Customized Common Industry Format Template for Electronic Health Record Usability Testing • Selecting an EMR for Your Practice: Evaluating Usability • Electronic Health Record Usability: Vendor Practices and Perspectives • Electronic Health Record Usability: Interface Design Considerations • Electronic Health Record Usability: Evaluation and Use Case Framework • Defining and Testing EMR Usability: Principles and Proposed • Methods of EMR Usability Evaluation and Rating • Technology Informatics Guiding Educational Reform (TIGER) Appendix B 48 • Informatics Roles and Functions in Healthcare Organizations References 50 ©2015 Healthcare Information and Management Systems Society. 4 Authors: Nancy Staggers (co‐lead) Melanie Rodney (co‐lead) Patricia Alafaireet Cecilia Backman Janet Bochinski Bob Schumacher Yan Xiao Contributing Editor: Edna Boone Usability Task Force Members: Organization: Patricia Alafaireet, PhD, MHA University of Missouri Patricia Arellano, MS Planned Systems International (PSI) Cecilia Backman, CPHQ, MBA, RHIA Parkland Health and Hospital System Janey Barnes (Chair), PhD User‐View Jeffrey Belden (Past Chair), MD, FAAFP University of Missouri Columbia Lyle Berkowitz (Advisory), MD Northwestern Memorial Physicians Group Janet Bochinski, MSN, PNP Encore Health Resources Edna Boone, MA, CPHIMS HIMSS Staff Liaison Victoria Bradley, DNP, RN, CPHIMS, FHIMSS University of Kentucky HealthCare Rollin (Terry) Fairbanks, MD, MS Medstar Institute for Innovation Rebecca Grayson User Reflections Shannon Houser, PhD, MPH, RHIA University of Alabama at Birmingham Scott Lind Siemens Daren Nicholson, MD, MBMI Axolotl Jas Phua Design for Context Melanie Rodney, PhD Macadamian Leigh Ruscher Ingenix Bob Schumacher, PhD User Centric Yalini Senathirajah, Phd Columbia University Center for Advanced Tech Bruce Sklar SAIC John Smelcer, PhD Fairfield professionals LLC Juhan Sonin MIT, Involution Studios Nancy Staggers, PhD, RN, FAAN University of Maryland MaryAnne Sterling, CEA Sterling Health IT Consulting, LLC Didier Thizy, PMP Macadamian Technologies Tiana Thomas LUMEDX Corp. Juanita Threat HIMSS Coordinator Cesar Torres, MS HIMSS Michelle Troseth, RN CPM Resource Center Yan Xiao, PhD Baylor Health Care System Po‐Yin Yen, PhD, RN Ohio State University Medical Center ©2015 Healthcare Information and Management Systems Society. 5 Executive Summary Federal funding in health IT is stimulating the adoption of electronic medical records and technical innovation necessary to improve our nation’s healthcare infrastructure and the systems of care it supports. Without end‐user acceptance of these new technologies, adoption and usage critical to improving healthcare processes will not occur. Organizational leaders will find it essential to improve the user experience in health organizations, such as users’ perceptions, responses and use of health products, systems and services. Issues with product usability are well‐documented. To that end, this document has three main purposes: describe the value of usability to healthcare organizations; outline a new health usability maturity mode; and provide initial steps for incorporating usability and improving the user experience in healthcare organizations. The document provides material for leaders and individuals in both healthcare organizations and vendor groups. By carefully examining the new usability maturity model and taking its prescriptions seriously, leaders and individuals can systematically improve attention to usability. Leaders may be reluctant to incorporate usability principles and practices because of perceptions that these methods may slow development and product fielding. However, data exist on usability return on investment (ROI), outlining the value of adopting usability in health organizations (see page 12). The diagram below visually defines ROI factors to be considered. Figure 1: The Value of Usability to Health Organizations ©2015 Healthcare Information and Management Systems Society. 6 Increased User Productivity/Efficiency Decreased User Errors/ Increase Safety Increased Individual Effectiveness, Efficiencies Improved Cognitive Support Improved patient, provider, Value of Usability organizational outcomes Decreased Maintenance Costs Increase Organizational Efficiencies Decreased Customer and Individual Training and Support Costs Decreased Development Time/ Costs The HIMSS Usability Task Force reviewed three existing usability maturity models from Earthy, Nielsen and Schaffer to assess their potential adoption into health settings (see page 16). Each was found to be incomplete; therefore, the task force used elements from the existing models to create a new Health Usability Maturity Model. This new model is described on page 24 and is diagrammed below. The Health Usability Maturity Model helps health leaders and individuals assess their levels of usability and then build toward more advanced levels. The model attributes are summarized within the diagram and demonstrate how the different phases of the model correlate with the level of maturity achieved when user‐centered design becomes fully integrated within a healthcare organization. Figure 2: Health Usability Maturity Model ©2015 Healthcare Information and Management Systems Society. 7 Focus on Process & Management Resources Education Users Infrastructure Phase 5- Strategic Phase 4- Integrated Phase 3- Implemented Phase 2- Preliminary Phase 1- Unrecognized Leaders and individuals may find four general tactics helpful in initiating usability into their organizations: discovering and documenting usability “wake‐up” calls, individual infiltration methods, finding internal champions and using external consultants as catalysts. Examples of initial steps for improving the user experience are outlined in the diagram that follows (see page 35). Figure 3: Initial Steps for Improving User Experience ©2015 Healthcare Information and Management Systems Society. 8 Include usability in contracts Create feedback loop from users to vendors Talk about tasks and workflows Educate about ROI related to usability Engage organizational leaders in usability Include usability metrics on one project Interview users to determine key usability issues Compile evidence from usability assessments Look for and document usability wake-up calls Find a business/organization driver supporting need for usability Three case studies (page 37) illustrate health organizations at different phases of usability maturity on the new Health Usability Maturity Model. The Department of Defense is at Phase 1, transitioning to Phase 2; Baylor Health Care Systems is at Phase 3 and the University Network in Toronto is at Phase 4 and moving to Phase 5. This material outlines the organizations’ impetus for usability, resources, projects and outcomes. Lastly, readers are provided with usability resources (see pages 40‐1), including summaries of current national work on usability and useful Web sites. The Usability Task Force’s goal is to improve awareness of usability in health organizations by providing tools for improving users’ experiences. ©2015 Healthcare Information and Management Systems Society. 9 Introduction Leaders and individuals must improve the user experience of health IT for individuals in health settings. That is to say, leaders need to better attend to health system users’ perceptions and responses on the use of products, systems and/or services. Current issues are well publicized—poor usability of electronic health records (EHR), sub‐optimal device design, awkward ergonomics and negative HEALTH ITHEALTH IT impacts on patients, patient safety, clinical productivity and efficiency after new products of various types are introduced. Individuals who select, customize, implement and use, and vendors who produce and/or modify HIT software have an interest in understanding usability maturity in their organizations. A major premise of usability is that software applications are based on an understanding of users’ needs; products are not produced in a vacuum or used in isolation. As with most enterprises,
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