UX/UI. How to improve doctors 'and nurses' experience with EHR?

October 15, 2022
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Everybody wants IT systems for doctors and nurses to be as easy to operate and as intuitive as smartphones. However, it is not that easy. Today's IT systems in healthcare are advanced and multi-functional tools that need to have reporting functions, securely collect data, manage the whole patient journey, correctly generate documents such as e-prescriptions and e-referrals, and exchange data with other systems in compliance with interoperability standards. Colloquially speaking, whether a given system is easy to operate or complicated is a very subjective impression. Everything begins with the structure of a given solution: the number of clicks needed to enter data, the clarity of the user interface, layout, fonts, field size, automatic form completion, and the flow of data in the system. The person responsible for the user's interactions with the system is a UX/UI (User Experience/User Interface) designer. Today, almost every IT company employs such people and they are responsible not only for making the application user-friendly and functional but also as easy to operate as possible, while ensuring that the necessary features are available. In short, the task of a UX/UI designer is to increase the satisfaction of using an IT system or mobile application and to make sure that the experience is positive. The work of a UX/UI designer starts with examining the features that the system needs to have, as well as interviewing users, which is used to identify their needs, sequences of work, the patient service path, and workflows. Then a process map is created and adjusted to the graphic design. Finally, everything ends with interface design, which determines the position of specific fields, options, windows, etc.

What affects the user experience?

The user experience (UX) has been defined by the International Organization for Standardization (ISO) as the "user's perceptions and responses that result from the use and/or anticipated use of a system, product, or service." UX has two layers: external design, which refers to an aesthetic assessment of what the system looks like (structure, style, colors, clarity), and the experience of operation, which is based on interactions. User experience is the result of a whole range of factors. It includes, for example, the emotions, beliefs, preferences, perceptions, physical and psychological reactions, behavior, and achievements of users, which happen before, during and after the use. In addition, there are elements such as the developer's external image, which may affect the initial positive or negative attitude toward a system. The speed of operation and performance are equally important, similarly to previous experiences, digital skills, and the context in which the system is used (screen size, room, etc.). Therefore, the matter is much more complicated than the first impression, which depends on the sense of aesthetics. While some people like system X, others will choose system Y, even though they have the same features.

UX has a significant impact on the work of personnel

The very definition of user experience shows that it is not only the supplier of the IT system but also the end user who is responsible for improvements in UX, and this aspect is very often overlooked. A classic example is the type and performance of the hardware on which medical staff uses the system. Accepting joint responsibility comes with a burden that many entities, not only in the medical sector, prefer to shift onto IT systems engineers and architects. It is much easier to look for software errors than identify and fix problems related to change management or building an innovative organizational culture. This has been proved by implementing the same IT system in various medical facilities. Such implementations are sometimes successful and leave the staff satisfied; other times, they fail and lead to frustration. This is why every medical facility should take a closer look at the interactions between its staff and the system. What is at stake is the time spent in front of a computer, smooth operation, employee satisfaction, time to talk with patients, and even clinical and business performance of a given entity. At the other extreme, there are threats such as organizational disruptions and chronic stress in employees, leading to burnout and low patient satisfaction. It must be admitted that healthcare professionals' negative experience of working with IT systems is historically conditioned. Many systems had their roots in the 90s when the first systems used for reimbursement with payers were developed. At that time, the only thing that mattered was functionality, whereas terms such as UX/UI were not even known. Over the years, new elements were added to simple reporting systems without major architectural changes. This way, the systems became more functional but time-consuming and challenging to operate. Luckily, present-day IT solutions for healthcare are usually modern and integrated systems developed on the basis of UX/UI knowledge – software developers want to create competitive and top-quality solutions. However, even developers are limited by the possibilities technology offers. For example, the most sensitive element of interactions between the user and the IT system is the keyboard – data must be entered manually. This will not change until the market can offer reliable and precise transcription technologies based on artificial intelligence so the interview with the patient can be automatically entered into the system while taking into account the necessity of ordering such data. Despite such limitations, medical facilities have many opportunities to affect system operation. Good IT systems have features that make it easier to customize how they operate and set up the manner of data input. For example, users can define internal glossaries that make it much easier to enter data. In addition, when integrated systems are implemented, data is shared between systems within the IT architecture of a given medical facility, so the data does not need to be entered twice.

Measuring and optimizing IT system operation

The starting point for optimizing the experience of IT system users is to measure it. To do that, you need to clearly identify the goal. The goal determines what exactly will be measured. For example, if you want to reduce the time spent on entering data into the IT system, you need to analyze the path of data input and look for ways to shorten or standardize it. But when the priority is work efficiency, you also need to consider the environment available to doctors and nurses: equipment, work organization, etc. It may also turn out that digitization has simply reinforced inefficient processes, which means that the IT system was applied to old workflows. Unfortunately, in this case, the software becomes as ineffective as the old processes. Implementing an IT system is not enough to improve the situation. To avoid that scenario, healthcare managers should use design thinking and user-centered (process) design (UCD) methods. For example, design thinking makes it possible to identify bottlenecks in patient service and redesign the care path, whereas UCD focuses on the ergonomics of working with systems. When it comes to IT, it includes, for example, adjusting the size of screens (large screens to analyze medical images better), the mobility of devices (a desktop computer or tablets), turning off warnings and notifications (alerts on drug interactions or missing data), etc.

Conclusion

The classic approach to the experience of working with an IT system assumes that it is a task for system providers. But, as it turns out, a medical facility can also do a lot to increase the satisfaction of doctors, nurses and administrative employees with regard to their interactions with software. It is clear that the starting point is always a good quality IT system that runs fast, is designed with intuitive operation in mind, and is free from errors. Equally important is a partnership with the company that developed the system and updates that enable the system to meet functional requirements and safety standards. Systems are not static. Reasonable solutions provide many configuration possibilities, such as adjusting the interface, the range of visible features, and alerts about errors in the entered data. The three core rules that are worth remembering are: first, optimize workflows before an IT system is implemented (or adjust them later if it was not done beforehand); second, take the time to analyze the users' needs and customize the system; and third, systematically measure the experience and correct potential disruptions.