“Improving the Care of Chronic Illness Through User-Centered EMR Design”
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Abstract
Although new technologies are being developed in healthcare on a daily basis, there is great opportunity to increase the potential of existing systems through more user-centered design. Electronic Medical Records (EMR) are an example of a system that has the potential to be leveraged as more than just an electronic means of storing records, but as a way to improve care management of patients with chronic illness. EMR systems have the capacity to support family physicians to care for this continuously growing patient population. However, poorly designed EMR systems are impeding this potential, as many providers find them inhibiting to their workflow, time-consuming and tedious to use. They suffer from non-intuitive interfaces that are difficult to navigate through. By integrating the end-user into the design of EMR tools and testing/evaluating the tools with providers and patients in real clinical settings, we have created an EMR-based toolkit that is provider-centered, encouraging adaptation into the management of chronic disease patients.
We developed a user-centered EMR-based toolkit to improve the care management of patients with atrial fibrillation (AF). Our process was informed by design thinking principles that engaged the end-user throughout the entire process. For example, to ensure a deep understanding of the end-users needs, we embedded front-line clinicians into our design team, which included a designer, a pharmacist, and three family physicians, one of which was a developer. Methods of engaging the clinicians included offering them academic opportunity and the chance to be early adopters of the software in their respective clinical sites. The clinicians articulated the limitations of current EMR systems, and their need for a toolkit that integrates seamlessly into their current workflow. In a series of iterative design sessions, this multi-disciplinary team collaborated to translate user needs into user-interface mock-ups that mapped out the ideal experience of using the EMR-based tool kit. The mock-ups were then implemented into the current EMR software for further evaluation and testing. This phase involved engaging an entire clinical site by offering them the opportunity of being first-time adopters of the tool-kit. In addition, participants of the pilot study were financially compensated for their time, and were provided with additional clinical tools both within and outside the EMR to support their workflow. Four front-line clinicians including three general practitioners and a nurse practitioner, were selected to test the prototype with mock patients. A research assistant and user-experience designer observed the mock sessions, evaluating the tool-kit’s ease-of-use and seamless integration into the clinician’s workflow.
In our current solution, whenever a family physician cares for an AF patient, a toolbar automatically appears in the patient’s EMR, prompted by an AF diagnosis being recorded in the patient’s record. The toolbar contains a toolkit which facilitates guideline-concordant stroke prevention, symptom management, and patient and provider education. Through rapid, iterative prototyping, we created an EMR-based toolkit that addresses the barriers presented by current EMR design when caring for these patients. The EMR toolkit is designed to fit seamlessly into the workflow of a patient office visit, centralizing their needs into tools that are easily accessible, such as ‘one-click’ patient education tools. In addition, the user-interface of the toolkit was created using the guiding principles of effective display design, ensuring simplicity, consistency, visibility, and overall ease of use. Early feedback from the user’s suggests that they value the toolkit and are likely to use it in their practice.
The design of this EMR-based toolkit illustrates an effective design process to create a user-centered intervention to a user-defined problem, leveraging the potential of an existing technology in healthcare. It is our belief that the integration of providers at very early stages of the process to contribute actively in the ideation/creation of the toolkit as well as taking the time to iteratively test the system at several stages throughout the process to inform its design will prove crucial in the successful adoption of a more provider-centered EMR system for patients with other diseases.
We developed a user-centered EMR-based toolkit to improve the care management of patients with atrial fibrillation (AF). Our process was informed by design thinking principles that engaged the end-user throughout the entire process. For example, to ensure a deep understanding of the end-users needs, we embedded front-line clinicians into our design team, which included a designer, a pharmacist, and three family physicians, one of which was a developer. Methods of engaging the clinicians included offering them academic opportunity and the chance to be early adopters of the software in their respective clinical sites. The clinicians articulated the limitations of current EMR systems, and their need for a toolkit that integrates seamlessly into their current workflow. In a series of iterative design sessions, this multi-disciplinary team collaborated to translate user needs into user-interface mock-ups that mapped out the ideal experience of using the EMR-based tool kit. The mock-ups were then implemented into the current EMR software for further evaluation and testing. This phase involved engaging an entire clinical site by offering them the opportunity of being first-time adopters of the tool-kit. In addition, participants of the pilot study were financially compensated for their time, and were provided with additional clinical tools both within and outside the EMR to support their workflow. Four front-line clinicians including three general practitioners and a nurse practitioner, were selected to test the prototype with mock patients. A research assistant and user-experience designer observed the mock sessions, evaluating the tool-kit’s ease-of-use and seamless integration into the clinician’s workflow.
In our current solution, whenever a family physician cares for an AF patient, a toolbar automatically appears in the patient’s EMR, prompted by an AF diagnosis being recorded in the patient’s record. The toolbar contains a toolkit which facilitates guideline-concordant stroke prevention, symptom management, and patient and provider education. Through rapid, iterative prototyping, we created an EMR-based toolkit that addresses the barriers presented by current EMR design when caring for these patients. The EMR toolkit is designed to fit seamlessly into the workflow of a patient office visit, centralizing their needs into tools that are easily accessible, such as ‘one-click’ patient education tools. In addition, the user-interface of the toolkit was created using the guiding principles of effective display design, ensuring simplicity, consistency, visibility, and overall ease of use. Early feedback from the user’s suggests that they value the toolkit and are likely to use it in their practice.
The design of this EMR-based toolkit illustrates an effective design process to create a user-centered intervention to a user-defined problem, leveraging the potential of an existing technology in healthcare. It is our belief that the integration of providers at very early stages of the process to contribute actively in the ideation/creation of the toolkit as well as taking the time to iteratively test the system at several stages throughout the process to inform its design will prove crucial in the successful adoption of a more provider-centered EMR system for patients with other diseases.
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