Patient Engagement, Usability, and Meaningful Use Stage 3

Patient Engagement

Patient engagement was a very hot topic at the recent HIMSS conference in Chicago. There was no shortage of exhibitors promoting their patient engagement tools and there were also several presentations that contained suggestions for better engaging patients. Some exhibitors that we spoke to were not aware of the proposed patient engagement rules (described below) and were very excited at the prospect of greater use of their tools.

Healthcare Usability and the Joint Commission

Usability was again a hot topic at HIMSS. Well, actually the lack of usability in healthcare software was again a hot topic at HIMSS. For many years, we have been a strong advocate for promoting Usability in healthcare (see . The Joint Commission provides detailed evidence for the need to create #SafeHealthIT.

The most salient catalyst to the many usability conversations that we had in Chicago was the Joint Commission’s Sentinel Event Alert number 54. The “Safe use of health information technology,” ( see ) in which the Joint Commission presents the case for improving the usability of healthcare software by explaining, amongst other, things how “Incorrect or miscommunicated information entered into health IT systems may result in adverse events.”

ONC and Meaningful Use Stage 3 (aka ONC 2105 Edition Certification, MACRA, MIPS)

The Office of the National Coordinator (ONC) released their proposed rules for Meaningful Use Stage 3 just in time to be top on the minds of majority of HIMSS attendees. ONC proposed an increase from five to 25 percent for getting patients to view, download, and transmit personal health data. They propose requiring that more than 35 percent of all patients seen by a provider or discharged from a hospital receive some type of a secure message using the electronic health record’s (EHR) electronic messaging function. They also call for more than 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting, to the EHR.

The proposed ONC requirements are a very tall order for many providers to satisfy, particularly when many of the EHR systems they are using provide a less than satisfactory user experience for the medical staff that use them. Adding an entire new user population, namely patients and patient caregivers, to the mix make patient engagement even more difficult.

How should EHR vendors create tools for Patient Engagement?

The answer, of course, is usability and user-centered design. Patient portals cannot merely output information from the patient chart (that is normally viewed by trained medical staff) in a fancy new view. Patient Portals need to be designed with the patient in mind.

In order to achieve the improved engagement, Patient Portals need to present information, and workflow, to the patient, and/or caregivers, that are easily understood and are useful to the patients or the caregivers.

Who are your users? What types of experiences and expectations do they have? What are their goals? Are there any industry standards that should be followed? In the software development cycles the thoughts and expectations of your users can be predicted by creating user persona(s). This is one of the first steps in doing User-Centered-Design.

The first step to creating an engaging, usable and useful patient portal would be to try to gain an understanding of it’s potential users. Go to their home or place of work. Go talk to as many as you can afford in the environment that they are most likely to use your portal. We call this conducting a “contextual inquiry”.

While you are there, look at some of the other common tools that they use every day. Ask them what they believe will be the most common tasks that they will access your portal to complete. Ask what they would like the portal to do for them.

Talk a number people and seem if any patterns emerge. You may notice that some users are interested in using the product one way, while another group is interested in using it in a completely different way. Use these patterns to create a number of “Persona’s” that you can use to drive your development efforts.

Design for the users--not the requirements

Use the persona’s to create realistic use cases based upon the real patient and caregiver needs that you understand based upon your research. Usability people often call these use cases “user journey maps.”

Now, when you design your portal to engage the patient around their tasks (and not merely to satisfy regulatory requirements) the end users/patients will find the information presented to be easy to understand, useful to them, and they will freely engage with your system.

Embracing Usability and user-centered design is the key to creating a patient portal that encourages patient engagement and ultimately a healthier, more informed, and satisfied patient.

 Our Chief Experience Officer, Bennett Lauber is a member of the ONC Health IT Policy Committee Implementation, Usability, and Safety Workgroup.  He shares his experiences working with EHR vendors with Federal regulators to influence public policy on the usability of health IT.

The Usability People conduct and report summative usability evaluations using the NISTIR 7742 Customized Common Industry Format Template for EHR Usability Testing—suitable for satisfying the Safety-enhanced Design criteria portion of your MU2 (and soon to be MU3) certification.