oia live and learn – himss overview

OIA Live and Learn – HIMSS OverviewHealth Informatics Staff: Charles Gepford: Introduction

Diane Bedecarre: Top 10 Usability Myths DebunkedJim Demetriades: Improving End User Adoption of New Systems with Human FactorsJoseph 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: 1-800-767-1750 access code # 20003

Top 10 Usability Myths DebunkedHIMSS 2013 Session 27Nancy Staggers & Lorraine Chapman

DATE/MONTH 2011

Diane BedecarréWorkforce Development Co-Lead, [email protected]

mailto:[email protected]

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 DevelopmentEfficiency + Effectiveness + Satisfaction =

USABILITY


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 useFact: Developers need to understand workflows and tasks to know

what information is needed

Myth # 3 Whoever has the Most features winsFact: Vet your current feature set. Less may be more

Myth # 4 If they like it on the desktop, they’ll love it on mobileFact: Context and tasks matter more

Myth # 5 If we allow clinicians to customize their screens they will be satisfiedFact: Develop information architecture for users’ workflow


Fact or Myth continuedMyth # 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 & FriendlyFact: Usability = Patient Safety

Myth # 8 Usability Stifles InnovationFact: Usability drives innovation. Got iphone?

Myth # 9 Usability is the Vendor ResponsibilityFact: Usability is a joint responsibility

Myth # 10 Meaningful Use Stage 2 is another year awayFact: Start preparing now---usability takes time


Usability Tools and Resources

HIMSS Usability Maturity Model available here: http://www.himss.org/resourcelibrary/ AHRQ Health Information Technology Tools and Resources page:http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919

TIGER Initiative Usability & Clinical Application Design: http://www.thetigerinitiative.org/resources.aspx

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

http://www.himss.org/resourcelibrary/

http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919

http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919

http://www.thetigerinitiative.org/resources.aspx

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 DemetriadesDirector, Human factors


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


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 taskTwo key areas of vulnerability:• mental model mismatches (real world vs. app)• task flow words on screen don’t make sense


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.

Challenges with Meaningful Use: EHR Satisfaction and Usability Diminishing

Joe GardnerDeputy Director

VA/DoD Health Information Sharing

28 March 2013



• 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

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• 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

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• 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:

http://www.acponline.org/pressroom/ehrs_survey.htm 16

http://www.acponline.org/pressroom/ehrs_survey.htm

March 28, 2013

HIMSS - Open Source UpdateMarch 28, 2013

Christine RhodesLinda Hebert


OSEHRA Community – Collaboration Platform

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OSEHRAGOV

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


Evolving StandardModules

Standard VistAIncreasing the# of Modules&# of Facilities

While Improving The Code throughOSEHRACertification

Open Source and the Public Sector


OSEHRA Strategy for Private Sector

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• Expand Market Opportunities• Improve the EHR and Health IT Product Offering• Lower the Cost of Using Products• Build OS Support Capacity

Community of Corporate MembersIndividual Members

Volunteerswww.osehra.org

OIA Live and Learn – HI KBSHIMSS ‘13 Educational Session Summary“Federal mHealth Policy 101 - Foundation for Healthcare Innovation”Jessica Jacobs, MHSA, [email protected]

28 MARCH 2013

Greg StaudenmaierHealth Standards Architect



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

mHealth Policy Continuum

Adoption

Safety/Efficacy

Communication

Privacy/Security

Agency Who What When Why HowMobile 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).


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 certification • 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

http://www.happtique.com/

http://www.happtique.com/


Resources

1. HIMSS 13 Annual Conference Handouts http://conference.himss.org/himss13/index.aspx (All sessions) http://conference.himss.org/himss13/pdfs/10.pdf (Session #10)

2. FDA Draft Guidance for Mobile Medical Applications (21 Jul 11) http://

www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf

3. mHIMSS Summary and Analysis of the Mobile Medical Applications Draft Guidance for Industry and Food and Drug (FDA) Staff http://

www.mhimss.org/resource/summary-and-analysis-mobile-medical-applications-draft-guidance-industry-and-food-and-drug-

4. mHIMSS Summary of mHealth Related Federal Policies, Guidances and Regulations http://

www.mhimss.org/resource/summary-mhealth-related-federal-policies-guidances-and-regulations5. Happtique Health App Certification Standards (27 Feb 13)

http://info.happtique.com/mobile-health-certification-standards6. Federal mHealth Collaborative (U.S. Department of Health and Human Services)

http://www.hrsa.gov/healthit/mhealth.html

http://conference.himss.org/himss13/index.aspx

http://conference.himss.org/himss13/pdfs/10.pdf



http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM263366.pdf



http://www.mhimss.org/resource/summary-and-analysis-mobile-medical-applications-draft-guidance-industry-and-food-and-drug-



http://www.mhimss.org/resource/summary-mhealth-related-federal-policies-guidances-and-regulations

http://www.mhimss.org/resource/summary-mhealth-related-federal-policies-guidances-and-regulations

http://info.happtique.com/mobile-health-certification-standards

http://info.happtique.com/mobile-health-certification-standards




QuestionsContact:

Greg [email protected]

651.308.3153


oia live and learn – himss overview

Documents

usability testing

underutilizationpoor

role of usability

usability myths debunkedhimss

usability drives innovation

myth continuedmyth

work myth

patient safety myth