How To Redesign The EMR User Experience

Seattle Children's Hospital is testing a new kind of data aggregator that focuses more on the front-end user experience rather than the underlying technology to provide a more complete, accessible snapshot of a patient's condition and status. The technology is intended to foster patient-centric communication and ultimately allow clinicians to provide better, more coordinated care.

"It's an incredible, new way to provide us with new ways of looking at information," Dr. Ari Pollack, an informatics leader at the hospital, said of the Seattle Children's Patient Information System, a custom-built, Web-based program that pulls data from electronic medical records and other information systems, then presents a variety of user-friendly snapshots of patients.

"EMRs are becoming increasingly more complex in terms of information going in," Pollack explained to InformationWeek Healthcare. "I was looking at them as an increasingly larger black box," Pollack said. He also had some difficulty coordinating data across the hospital's Cerner inpatient EMR and registration, billing, and scheduling technology from rival vendor Epic Systems.

The complexity "makes it hard to tell the patient's story," Pollack said.

"It was hard for physicians to get a holistic, complete story of a patient," added Olen Ronning, lead designer and a founding employee of Artefact Group, a Seattle-based technology product design firm that Seattle Children's tapped to build the prototype aggregation system.

About a year and a half ago, Cerner introduced some new functionalities, including an application provider interface through which third parties could develop add-on technologies. This also was just a couple of months after the iPad was introduced, and Apple's groundbreaking tablet had doctors excited. "How can we leverage these possibilities?" Pollack wondered.

Pollack saw this as a prime opportunity to bring in the Artefact Group for a completely different perspective on how to extract data from disparate systems and present the information in better ways.

Dave McColgin, a lead researcher at Artefact, was struck by the lack of attention given to the user experience. "It felt like the investment was really on the back end of the system," McColgin said. Health IT systems tend to be sold on the back end, highlighting integration and high uptime, while many other industries put more emphasis on the front-end user interface.

Artefact principal and co-founder Gavin Kelly was flabbergasted by how many "analog" components he saw in the hospital environment, such as white boards and sticky notes to communicate among clinicians. "It was a bit alarming," Kelly said.

Seattle Children's leaders realized they needed a better way of organizing and communicating data. "It was more than bringing data elements into a dashboard, but also capturing things not in the computer before," Ronning said.

Pollack asked Artefact to help improve how clinicians accessed the various modules of the hospital's inpatient systems. "We looked at the initial requests and sort of reframed it to have a larger impact." Kelly said. "We reframed it in terms of the mobile tablet." That helped get user buy-in, Kelly said.

Artefact held several workshops with different hospital constituencies to get them thinking about the patient experience, then the company observed workflows and interviewed users. The designers tried to determine how many people talked to patients in the emergency room and how many asked the same questions. What paperwork needed to be filled out during the admissions process?

They then interviewed hospital administrators. "There, we got a good perspective about what their business goals were and how they overlapped with clinical goals," McColgin reported.

Artefact ended up building a Web-based tool so it works as well on a desktop as it does on a mobile device, according to Ronning. "That also allowed us to keep the data more secure," Ronning said.

McColgin said the Seattle Children's Patient Information System initially presents a list of patients and their status so physicians can quickly determine who needs the most immediate attention. Doctors can sort patients by overall health, trends, or readiness for discharge. The view allows users to see right away where a patient is, such as with a respiratory therapist or an imaging technician, and, via a checklist, mark off steps needed before discharge.

"Working toward discharge, that was kind of like the rallying cry," Ronning said. The system includes a benchmarking function, giving an idea of whether each patient is progressing on schedule. Users can view and send messages showing when test results are available, and clinicians can share information with other professionals involved in a particular care process, since all team members and their contact information are embedded in each screen.

There's also a dashboard to measure performance of units and teams, to help manage patient flow. For example, when a physician enters a discharge order, transportation gets called to send up a wheelchair and room status will change from occupied to dirty, signaling the cleaning staff to get to work.

The system supports multiple roles and locations, so, for example, a physician could get the same information while doing rounds or while sitting in an office.

Since the Seattle Children's Patient Information System still is a prototype, it has not been tested with any real patients yet. The next step is to figure out what fits with the hospital's workflow and perhaps tweak the prototype somewhat. "We need to spend more time to figure out how we want to use it," Pollack said. "We're going to explore what's possible with all the technology."

The Healthcare IT Leadership Forum is a day-long venue where senior IT leaders in healthcare come together to discuss how they're using technology to improve clinical care. It happens in New York City on July 12. Find out more.