Putting the “U” in EHR Usability℠: The Federal Health IT Five Year Strategic Plan

Short link: http://ehr.bz/b6

The Office of the National Coordinator for Health Information Technology (ONC) recently published the Federal Health Information Technology Strategic Plan for 2011 – 2015 (announcement, pdf).

The word “usability” is used twenty-five times.

Not going to read the full 80 pages (shame on you!) but want to stay up to date about government plans for improving EMR EHR usability? You came to the right blog post. I’ve abstracted each use of “usability” below. Emphases in bold are my own.

P.S. I like the HealthIT.gov’s tagline: Putting the “I” in Health IT℠. So much so, I’m going to use the parallel-themed tagline, Putting the “U” in EHR Usability℠, for a new website I working on. “U” refers to “you” the “user”. Stay tuned!

From the strategic plan:

pp 12-13

Strategy I.A.9: Encourage and facilitate improved usability of EHR technology.

The government is collaborating with industry and researchers to improve the usability of EHRs. The usability of EHRs is considered a key barrier to adopting health IT and achieving meaningful use. NIST is conducting ongoing research and advancing the development of standards and test methods that can be used to evaluate and improve the usability of EHRs. It has released a Common Industry Format (CIF), a standard for developers to report usability test findings and demonstrate evidence of usability in their products in a format that allows for independent evaluation of a single product and comparison across multiple products. NIST is also developing guidance and tools for RECs and professional societies on available tools and resources to incorporate concepts of usability in selecting and implementing EHR systems. The Food and Drug Administration (FDA), in collaboration with NIST and the Agency for Healthcare Research and Quality (AHRQ), will develop best practices to address systematic evaluation of usability with regard to patient safety to ultimately improve patient care. AHRQ is developing toolkits that medical practices can use to assess the usability of EHR systems and assess the redesign workflow. In addition, AHRQ is conducting research and convening industry workgroups that provide perspectives on what constitutes usability and how to systematically improve the usability of EHRs.

ONC will explore ways to improve the ability of providers to select or change EHR products by improving data portability. Reducing the cost associated with switching products while increasing data fluidity and choice can help drive market competition to improve the usability of EHR products.

ONC has directed one of its four Strategic Health IT Advanced Research Projects (SHARP) (see Strategy V.B.2) to further EHR usability through the identification and development of better cognitive and user-centered design. In addition, ONC is working with private sector groups to encourage the collection of usability information and its dissemination to vendors and consumers through mechanisms they can trust.

p 34

OBJECTIVE C Improve safety and effectiveness of health IT

Strategy III.C.1: Provide implementation and best practice tools for the effective use of health IT.

AHRQ’s Health IT Portfolio supports health services research grants and contracts that create new knowledge, synthesize and disseminate best evidence and provide tools for implementation addressing health IT’s impact on the quality of health care. Current initiatives address clinical decision support, patient safety, patient centered care, quality measurement, and usability and workflow issues. In addition, ONC is actively working to make resources available to providers that allow them to maximize the value of using health IT by avoiding common challenges and legal issues associated with adoption, implementation, and use of EHRs and other health IT. Professional societies, licensing boards, and continuing education programs are developing best practice resources related to issues such as workflow redesign, the need for ongoing maintenance and upgrades, and legal concerns related to vendor contract clauses. There are important legal issues that providers should be aware of when entering into agreements with EHR and other health IT vendors. ONC will work to equip providers with information and help address potential barriers they may face in achieving meaningful use, including improved usability of EHR technology (see Strategy I.A.9). ONC and RECs will ensure that appropriate best practice resources about these issues are distributed to the providers that need them.

p 41

Accommodate the range of user capabilities, languages and access considerations, including effective strategies for ensuring accessibility and usability of electronic health information for people with disabilities and meaningful access to such information for individuals with limited English proficiency

p 47

Accommodate the range of user capabilities, languages and access considerations, including effective strategies for ensuring accessibility and usability of electronic health information for people with disabilities and meaningful access to such information for individuals with limited English proficiency

p 48

Strategy V.B.2: Make targeted investments in health IT research. The federal government is committed to investing directly in health IT research and development in areas that hold great promise for improving the health of individuals and populations. NIH and ARHQ, in particular, are funding dozens of research projects related to the development of health IT. Through the HITECH Act, ONC established the Strategic Health IT Advanced Research Projects (SHARP) Program, a four-year program funding research in health IT security, patient-centered cognitive support, health care applications and network platform architectures, and secondary use of EHR data. The progress made by grantees will assist in developing best practices which can be applied nationwide, possibly through meaningful use requirements. AHRQ sponsors projects focused on best practices and integration of health IT into the practice of medicine. Focus topics include usability of EHRs, clinical decision support, consumer health IT, health information exchanges, and telehealth.

p 51

Appendix B: Programs, Initiatives, and Federal Engagement

NIST collaborates with HHS/ONC in realizing the health IT goals of the Administration and Congress. This relationship allows ONC to draw upon NIST expertise in applying IT to health care through standards, conformance measurement, prototype implementation, security, and usability, and in consulting on the Nationwide Health Information Network, standards, and certification processes.

p 52

NIST has funded a grant on the “Relationship Between Health IT Usability and Patient Safety: A Human Factors Engineering Framework for Action.” This grant will develop a framework explaining how the multiple facets of usability may be linked to different aspects of patient safety.

AHRQ’s Health IT Portfolio has supported health services research grants and contracts that create new knowledge, synthesize and disseminate best evidence and provide tools for implementation addressing health IT’s impact on the quality of health care since 2004. Current initiatives address clinical decision support, patient safety, patient centered care, quality measurement, and usability and workflow issues.

p 60-61

Testing the usability and feasibility of smartphone-based applications and patient links to clinical services, including, but not limited to a recovery tool called Addiction Comprehensive Health Enhancement Support System (A-Chess) – an online peer support group and clinical counselors, a GPS feature that sends an alert when the user gets near an area of previous drug or alcohol activity, real-time video counseling, and a “panic button” that allows the user to place an immediate call for help with cravings or triggers.

p 70

Appendix F: Goals, Objectives, and Strategies

Goal I: Achieve Adoption and Information Exchange through Meaningful Use of Health IT

Objectives

Strategies

I.A. Accelerate adoption of electronic health records

I.A.9. Encourage and facilitate improved usability of EHR technology.

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