2006 EHR WfMS Tutorial Slides 15-22: EMR EHR Usability Principles and Workflow: Introduction

(Take me to the beginning of these slides!)

These slides are from 2006, but this text is a mixture speaker notes from the 2004-2006 presentation plus more recent presentations, white papers, book chapters and blogs.

From Chapter 7: Natural Language Processing, Business Process Management, and Adaptive Case Management in Healthcare in How Knowledge Workers Get Things Done: Real-World Adaptive Case Management:

“I am a fan of five EHR workflow usability principles:

  • Naturalness—is there a natural fit between EHR workflow and task work-flow?
  • Consistency—do similar activities have similar workflows?
  • Relevance—does the EHR not show you too much data or too many options?
  • Support—can you see, at a glance, all pending tasks and related information?
  • Flexibility—can you fix unnatural, inconsistent, irrelevant, unsupportive workflow?

I’ll quote from my 2004 MedInfo short paper here….

‘EHR workflow management systems are more usable than EHRs without work-flow management capability. Consider these usability principles: naturalness, consistency, relevance, supportiveness, and flexibility. EHR WfMSs more natural-ly match the task structure of a physician’s office through execution of workflow definitions. They more consistently reinforce user expectations. Over time this leads to highly automated and interleaved team behavior. On a screen-by-screen basis, users encounter more relevant data and order entry options. An EHR WfMS tracks pending tasks–which patients are waiting where, how long, for what, and who is responsible–and this data can be used to support a continually up-dated shared mental model among users. Finally, to the degree to which an EHR WfMS is not natural, consistent, relevant, and supportive, the underlying flexibil-ity of the WfMS can be used to mold workflow system behavior until it becomes natural, consistent, relevant, and supportive.’

[By the way, I wrote the ghost-wrote the referenced 2003 Advance for Health Information Management Executives article]

Let’s deal with these five workflow usability principles one by one. In each case we’ll nod toward cognitive science, but not drive into weedy details.”


Five EMR EHR Workflow Usability Principles

  • Naturalness
  • Consistency
  • Relevance
  • Supportiveness
  • Flexibility


Past Emphasis
System Usability less emphasis than Info Value


Current Emphasis
System Usability equal emphasis to Info Value


Traditional Usability
Usability is the effectiveness, efficiency and satisfaction with which specific users achieve specific goals in specific contexts (based on ISO 9241-11 definition)


Workflow Usability
Usability is the effectiveness, efficiency, and satisfaction with which teams of users achieve collections of goals in complex environments.


Principles to Increase Usability

  • Naturalness
  • Consistency
  • Relevance
  • Supportiveness
  • Flexibility


  • Learnability
  • Throughput
  • Satisfaction
  • (Patient Safety)


Usability Examples

Bicycle MS Office EMR EHR UI EMR EHR Workflow

(Take me to the beginning of these slides!)

Related links:

EHR/EMR Usability: Natural, Consistent, Relevant, Supportive, Flexible Workflow

TEPR 2004 EHR Workflow Management System Slides

Based on the slide deck used for three-hour tutorial at the 2004 TEPR conference in Fort Lauderdale.

TEPR 2006 EHR Workflow Management Systems Slides

Based on the slide deck used for three-hour tutorial at the 2006 TEPR Conference in Baltimore.

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