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OIA Live and Learn – HIMSS Overview

OIA Live and Learn – HIMSS Overview. Health Informatics Staff: Charles Gepford: Introduction Diane Bedecarre: Top 10 Usability Myths Debunked Jim Demetriades: Improving End User Adoption of New Systems with Human Factors

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OIA Live and Learn – HIMSS Overview

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  1. OIA Live and Learn – HIMSS Overview Health Informatics Staff: Charles Gepford: Introduction Diane Bedecarre: Top 10 Usability Myths Debunked Jim Demetriades: Improving End User Adoption of New Systems with Human Factors Joseph Gardner: Challenges of Meaningful Use – Survey of Clinicians/User Satisfaction  Christine Rhodes/Linda Hebert: Open Source / OSEHRA Greg Staudenmaier: Federal mHealth Policy 101 – Foundation for Health Care Innovation  VANTS: 1-800-767-1750 access code # 20003

  2. Top 10 Usability Myths Debunked HIMSS 2013 Session 27 Nancy Staggers & Lorraine Chapman Diane Bedecarré Workforce Development Co-Lead, hi2 Diane.Bedecarre@va.gov DATE/MONTH 2011

  3. Why Do We Care About Usability? • Workflow is the # 1 usability pain point • Increased disillusionment among end users • Low adoption rate or underutilization • Poor usability contributes to medical errors • Incentives---Meaningful Use Stage 2 and 3 • Role of Usability in Development • Efficiency + Effectiveness + Satisfaction = USABILITY

  4. Fact or Myth? • Myth # 1 Clinicians are Uncomfortable with Technology and just need more training • Fact: Current HIT systems often don’t fit the way end users think and work • Myth # 2 Put it all on 1 screen to make it easier to use • Fact: Developers need to understand workflows and tasks to know what information is needed • Myth # 3 Whoever has the Most features wins • Fact: Vet your current feature set. Less may be more • Myth # 4 If they like it on the desktop, they’ll love it on mobile • Fact: Context and tasks matter more • Myth # 5 If we allow clinicians to customize their screens they will be satisfied • Fact: Develop information architecture for users’ workflow

  5. Fact or Myth continued • Myth # 6 Usability is subjective • Fact: There are many types of usability measures (performance, cognitive, perceptions, motivation, costs, risk management etc.) • Myth # 7 Usability = Only Pretty & Friendly • Fact: Usability = Patient Safety • Myth # 8 Usability Stifles Innovation • Fact: Usability drives innovation. Got iphone? • Myth # 9 Usability is the Vendor Responsibility • Fact: Usability is a joint responsibility • Myth # 10 Meaningful Use Stage 2 is another year away • Fact: Start preparing now---usability takes time

  6. Usability Tools and Resources • HIMSS Usability Maturity Model available here: • http://www.himss.org/resourcelibrary/ • AHRQ Health Information Technology Tools and Resources page: • http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919 • TIGER Initiative Usability & Clinical Application Design: • http://www.thetigerinitiative.org/resources.aspx • Video Lectures on TMS: • Interface Design Standards and Principles – Staggers • Human Computer Interaction: Evaluation, Usability Testing, Study Design and Methods – Elkin • Models, Theories and Practices of Human Computer Interaction- Patel

  7. OIA Live and Learn – Human Factors Takeaways from HIMSS 2013 session: Improving End User Adoption of New Systems with Human Factors by Anna Haskvitz Jim Demetriades Director, Human factors 26 April 2013

  8. New Systems Stress Users Most common problems: Too difficult to use Missing features System is slow Features weren’t rolled out together with other capabilities (piecemealed) Human Factors can help with the first two

  9. Post-Development Diagnostics When doing staged user research: verify there is actually a usability problem determine how impactful the problem is determine how well the software supports the user task Two key areas of vulnerability: mental model mismatches (real world vs. app) task flow words on screen don’t make sense

  10. Recommendations • Task flow words on screen are often just noise to a user who often cannot explain what the words mean.  This usually leads to low task completion and user frustration. • Test to make sure target users understand every word and what real world task it supports. • Reduce visual noise by matching screen with user’s mental model…often requires different screens for different user roles.

  11. Challenges with Meaningful Use: EHR Satisfaction and Usability DiminishingJoe GardnerDeputy DirectorVA/DoD Health Information Sharing 28 March 2013

  12. Challenges with Meaningful Use: EHR Satisfaction and Usability Diminishing • Based on survey of over 4,000 providers conducted by the American College of Physicians and the AmericanEHR Partners, satisfaction and usability ratings for EHRs have decreased since 2010: • 50% of surveyed clinicians had greater than three years experience with their EHR system(s) • Overall satisfaction fell 12% • “Very dissatisfied users increased 10% • 34% very dissatisfied with ability of EHR to decrease workload • 37% dissatisfaction with EHR “ease of use” • 82% of respondents intend to participate in Meaningful Use, but concerns about reaching MU Stages: • Stage 2: Implement by 2014 with advanced clinical processes and more rigorous health information exchanges • Stage 3: Implement by 2016 with improved health outcomes and decision support for national high-priority conditions

  13. Challenges with Meaningful Use: EHR Satisfaction and Usability Diminishing • EHR product concerns included: • Too much too fast • Lack of training • Need for additional clinical specialty specific capabilities • Ability to document progress notes • Rebalancing workload in conjunction with EHR use: • Workflow • Clinical specialty needs • Clinical quality measures • Data entry time consuming • Patient dissatisfaction of provider utilizing computer during encounter • Vendor lack of ability or reluctance to make system modifications • Smaller vendors apparently do this better

  14. Challenges with Meaningful Use: EHR Satisfaction and Usability Diminishing • Possible mitigations for concerns: • Empower clinicians: • Early in system requirements and acquisition process • User feedback loop • Place emphasis on clinical use of problem list and pharmacy data vice decision support (survey results) • Manage Meaningful Use expectations • Adopt early and ongoing training • Maintain balance between fee for service and clinical documentation motivations • Incorporation into/interface with any existing HIE system components • References: • HIMSS 13 Education Session #61 • AmericanEHR News article: http://www.acponline.org/pressroom/ehrs_survey.htm

  15. HIMSS - Open Source UpdateMarch 28, 2013Christine RhodesLinda Hebert March 28, 2013

  16. OSEHRA Community – Collaboration Platform • CORP- SYS INTEGRATOR • COMMERCIAL PRODUCTS • SALES AND SERVICE • MIX AND MATCH • CONTRIBUTE- APACHE 2.O • HELP FIX AND IMPROVE • GOVERNMENT • CULTURAL CHANGE • CONTIBUTE CODES • PARTICIPATE • IN TAKE AND ADOPT • PROCURE SERVICES • OSEHRA • OPEN REPOSITORY • ACCEPT &REVIEW • OPEN TEST • ASK TO FIX • CERTIFY • MANAGE PRODUCTS • DEV ENVIRONEMENT • APACHE 2.0

  17. Open Source and the Public Sector Standard VistA Increasing the # of Modules & # of Facilities While Improving The Code through OSEHRA Certification Evolving Standard Modules

  18. OSEHRA Strategy for Private Sector • Expand Market Opportunities • Improve the EHR and Health IT Product Offering • Lower the Cost of Using Products • Build OS Support Capacity Community of Corporate Members Individual Members Volunteers www.osehra.org

  19. OIA Live and Learn – HI KBS HIMSS ‘13 Educational Session Summary “Federal mHealth Policy 101 - Foundation for Healthcare Innovation” Jessica Jacobs, MHSA, CPHIMS jjacobs@healthcareinnovation.us Greg Staudenmaier Health Standards Architect 28 MARCH 2013

  20. Summary • Jessica Jacobs is an Oak Ridge Institute for Science and Education Fellow stationed at the Food and Drug Administration’s Center for Drug Evaluation and Research. She helped stand up the Federal mHealth Collaborative and currently leads FedTel’s “Technology, Innovations, and Standards” workgroup. • Presentation output of mobile HIMSS (mHIMSS) Summary of ”Health Related Federal Policies, Guidances and Regulations”, produced by mHIMSS Taskforce: Policy and Regulatory Implications Workgroup. • The session primarily focused on regulatory oversight of mobile health application (mHealth) development. • High level overview of federal agencies and their relationship to mHealth regulation, i.e. “who, what, when, why and how” • My interest primarily related to health standards criteria for mHealth apps

  21. mHealth Policy Continuum

  22. Talking Points • Very complex landscape of federal government regulatory oversight • Definition: “mHealth is the use of mobile and wireless devices to improve health outcomes, healthcare services, and health research”, (2011 NIH Consensus Group) • Estimates of mHealth apps range from 23K-40K and quickly growing • 100 mobile medical apps reviewed for FDA clearance (21 March 2013) • Explicit FDA definitions for Mobile Platform, Mobile Application (mobile App) and Mobile Medical Application and corresponding FDA classes (I, II, III) and requirements • Happtique (http://www.happtique.com/) standards and certification • Bring Your Own Device (BYOD) and use your own apps presents challenges for healthcare delivery organizations, e.g. privacy, security, interoperability, etc. • Future Meaningful Use criteria (stage 3?) for patient generated health data and aggregation with EHR

  23. Resources • HIMSS 13 Annual Conference Handouts • http://conference.himss.org/himss13/index.aspx (All sessions) • http://conference.himss.org/himss13/pdfs/10.pdf (Session #10) • FDA Draft Guidance for Mobile Medical Applications (21 Jul 11) • http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf • mHIMSS Summary and Analysis of the Mobile Medical Applications Draft Guidance for Industry and Food and Drug (FDA) Staff • http://www.mhimss.org/resource/summary-and-analysis-mobile-medical-applications-draft-guidance-industry-and-food-and-drug- • mHIMSS Summary of mHealth Related Federal Policies, Guidances and Regulations • http://www.mhimss.org/resource/summary-mhealth-related-federal-policies-guidances-and-regulations • Happtique Health App Certification Standards (27 Feb 13) • http://info.happtique.com/mobile-health-certification-standards • Federal mHealth Collaborative (U.S. Department of Health and Human Services) • http://www.hrsa.gov/healthit/mhealth.html

  24. Questions • Contact: • Greg Staudenmaier • greg.staudenmaier@va.gov • 651.308.3153

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