An ounce of prevention -- is worth a pound of cure

Residents in the commonwealth of Virginia must take their car for a “safety inspection” each year. The test criteria is published by the state and it is fairly easy to determine in advance if your car is going to pass the inspection. Before you take your car for inspection, first you make sure that all lights are functional, the tires all have proper tread, the windshield wipers are working, etc. If you find anything, you make a small fix BEFORE going to the inspection station and will save the hassle of dealing with a failed test. An ounce of prevention.

Summative Evaluations for §170.315(g)(3) Safety-enhanced design

The Office of the National Coordinator for Health Information Technology (ONC) requires that EHR vendors include summative usability test results for the Safety-enhanced Design portion of their 2015 Edition certification submission. The usability reports for ONC certified EHRs are published on the Certified Health IT Product List (CHPL). Why would EHR software vendors go through a formal test procedure without knowing or understanding the potential usability issues with their EHR system? Why would a company want to expose the usability issues in their system for potential review and/or exploitation by their competitors?

There are many example of published and somehow certified studies for the 2014 Edition certification program that expose a lot of issues with the usability of the systems (and the quality of the evaluation).

See for our take on Meaningful Use, MACRA, MIPS and the ONC 2015 Certification

Summative usability testing for safety-enhanced design involves recruiting targeted users as test participants (Doctors, Nurses, and other medical practitioners) and asking these users to complete a set of pre-defined tasks. An expert test facilitator conducts the testing via an established test protocol while the test sessions are recorded and later analyzed.

Just like a vehicle safety inspection, the SAT or GRE, summative evaluations are used to determine if the design meets specific measurable performance and/or satisfaction goals.

Formative evaluations are the answer!

Formative evaluations are a type of usability evaluation that helps to "form" the design for a product or service. Heuristic evaluations (aka Expert reviews), user interface inspections, thinking-aloud testing, pluralistic usability walkthrough, and cognitive walkthrough are some methods that can be used for formative evaluation. Formative evaluations are a cost effective way to find potential usability issues with an EHR. They involve evaluating the interface of the EHR during development, often iteratively, with the goal of detecting and eliminating usability problems.

Before running the summative usability evaluation for §170.315(g)(3) Safety-enhanced design we recommend that EHR vendors begin working with a usability expert ( ) to identify possible usability issues before they are exposed as “dirty laundry” in a formal report.

A Usability expert, that knows and understands the ONC 2015 Edition certification test protocol can examine the user interface and user interaction patterns of an EHR and provide a list of potential area of improvement. The reports would typically also contain actionable feedback that the vendor can take directly to their development team for implementation--before the summative test!

A few “quick” fixes to the interface of an EHR can go a long way to providing that ounce of prevention - and lead to a pound of cure.