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OIA Live and Learn – HIMSS Overview Health Informatics Staff: Charles Gepford: Introduction Diane Bedecarre: Top 10 Usability Myths Debunked Jim Demetriades:

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Presentation on theme: "OIA Live and Learn – HIMSS Overview Health Informatics Staff: Charles Gepford: Introduction Diane Bedecarre: Top 10 Usability Myths Debunked Jim Demetriades:"— Presentation transcript:

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: access code # 20003

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3 Top 10 Usability Myths Debunked HIMSS 2013 Session 27 Nancy Staggers & Lorraine Chapman DATE/MONTH 2011 Diane Bedecarré Workforce Development Co-Lead, hi2

4 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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

5 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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

6 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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

7 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics Usability Tools and Resources HIMSS Usability Maturity Model available here: AHRQ Health Information Technology Tools and Resources page: es/919 TIGER Initiative Usability & Clinical Application Design: 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

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

9 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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

10 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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

11 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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.

12 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics

13 Challenges with Meaningful Use: EHR Satisfaction and Usability Diminishing Joe Gardner Deputy Director VA/DoD Health Information Sharing 28 March 2013

14 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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

15 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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

16 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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: 15

17 March 28, 2013 HIMSS - Open Source Update March 28, 2013 Christine Rhodes Linda Hebert

18 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics OSEHRA Community – Collaboration Platform 17 OSEHRA GOV CORP CORP- SYS INTEGRATOR COMMERCIAL PRODUCTS SALES AND SERVICE MIX AND MATCH CONTRIBUTE- APACHE 2.O HELP FIX AND IMPROVE OSEHRA OPEN REPOSITORY ACCEPT &REVIEW OPEN TEST ASK TO FIX CERTIFY MANAGE PRODUCTS DEV ENVIRONEMENT APACHE 2.0 GOVERNMENT CULTURAL CHANGE CONTIBUTE CODES PARTICIPATE IN TAKE AND ADOPT PROCURE SERVICES

19 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics Evolving Standard Modules Standard VistA Increasing the # of Modules & # of Facilities While Improving The Code through OSEHRA Certification Open Source and the Public Sector

20 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics OSEHRA Strategy for Private Sector 19 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 Community of Corporate Members Individual Members Volunteers

21 OIA Live and Learn – HI KBS HIMSS ‘13 Educational Session Summary “Federal mHealth Policy Foundation for Healthcare Innovation” Jessica Jacobs, MHSA, CPHIMS 28 MARCH 2013 Greg Staudenmaier Health Standards Architect

22 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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

23 mHealth Policy Continuum AdoptionSafety/EfficacyCommunicationPrivacy/Security

24 AgencyWhoWhatWhenWhyHow Mobile Medical Apps: Health and Human Services, Food and Drug Administration Device Manufacturers- the people who design, manufacturer, label, or create software applications. This includes health systems, insurance companies, private Health IT vendors and others who market mobile medical applications (apps.). Distributors – platforms for selling/advertising the application. Not responsible for the applications functionality, but are responsible for cooperating with updating the product in alignment with the Manufacturers. Mobile Medical Apps: a mobile app that meets the definition of "device" in section 201(h) of the Federal Food, Drug, and Cosmetic Act (FD&C Act); and its intended use is: 1.as an accessory to a regulated medical device 2.to transform a mobile platform into a regulated medical device Regulations apply to displaying, storing and transmitting information; controlling connected medical devices; transforming mobile platforms, and interpreting medical device data. In effect.To protect patients from unintended, potentially dangerous, effects of mobile medical applications which are ineffective or might cause harm. If the mobile medical app falls within a specific medical device classification or augments functionality to a specific medical device classification, manufacturers are immediately subject to meet the requirements of that classification (either I, II, or III).

25 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics 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 certificationhttp://www.happtique.com/ 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

26 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics Resources 1.HIMSS 13 Annual Conference Handouts  (All sessions)  (Session #10) 2.FDA Draft Guidance for Mobile Medical Applications (21 Jul 11)  s/UCM pdf s/UCM pdf 3.mHIMSS Summary and Analysis of the Mobile Medical Applications Draft Guidance for Industry and Food and Drug (FDA) Staff  guidance-industry-and-food-and-drug- guidance-industry-and-food-and-drug- 4.mHIMSS Summary of mHealth Related Federal Policies, Guidances and Regulations  regulations regulations 5.Happtique Health App Certification Standards (27 Feb 13)  6.Federal mHealth Collaborative (U.S. Department of Health and Human Services) 

27 VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics Questions Contact: Greg Staudenmaier


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