Hospice EMR Design: Usability is Your Greatest Audit Shield
Jared Spool, the writer, researcher and usability expert, once said: “Good design, when it’s done well, becomes invisible. It’s only when it’s done poorly that we notice it.”
Often though, poor design may not be noticed at first glance and only hits you when you’re using the product. By then it’s too late; you’ve bought the product, thrown away the packaging, lost the receipt, and only discovered the flaw at the exact moment you really need it to work seamlessly.
Take a look at this baby monitor:
You hear your toddler crying.
Tiredly fumbling around in the dark you grab the monitor to talk and soothe your baby and realize that just maybe the choice to place the talk button next to the power button is a design flaw that undercuts the value proposition of the product.
A quick glance at the box or even testing the product while shopping in a brightly lit store when you’re wide awake with a salesperson touting the product’s benefits may not provide the clarity and circumstances you need to know if the product will actually work for you in the real world application.
If Vtech had given their monitor to employees with babies to test before releasing to the public, they would have quickly found out that what a product looks like on a drawing board, or testing in a lab, does not translate to design that works.
Good or bad design isn’t just about product usability. Design impacts how efficiently and effectively information flows.
Look at these parking signs:
If you are looking for parking at 10 am on a Wednesday morning, can you park here?
When you look at this signage and can’t answer that question in one quick glance, and instead need to seriously calculate all this information before you can confidently make what should be a simple yes or no decision, that’s a design fail.
The information overload here developed because of common design flaws:
1. Text instead of visuals.
2. New modules with new information added to preexisting modules.
Compare the multi-module text-based signage to this parking sign that is a single yet comprehensive and visual based module:
With a single glance you can immediately see when you are allowed and when you are not allowed to park at this location.
The signage example, a situation where we need to display a lot of information that needs to be quickly digested displayed in a small space, is in many ways similar to designing software, especially for mobile apps. It’s a common struggle, how do you display efficiently & effectively display information in a way that makes your software usable and functional without causing information-overload.
Hospice Software. Better Design, Better Outcomes
Software for the hospice industry, like much of healthcare, is particularly concerning as patients’ health and well-being is on the line. At the same time, the software users, especially clinicians such as doctors and nurses, are overwhelmed, under pressure, understaffed, and often not tech savvy.
On the other side of the equation, the software designers and developers, especially when you get to the large software conglomerates with consultant based conceptualizations and board room decision making, are far removed from the field and lack the expertise and intuitive understanding of what works and doesn’t work for day to day workflows.
Henry Ford once said, “If I had asked people what they wanted, they would have said faster horses.”
Asking people what they want is not just OK it’s actually recommended as a best practice. But the real trick is understanding their answer. When the mythical consumer in Ford’s quote replied ‘faster horses’ what they meant was, a faster, better mode of transportation. But they didn’t have the language or knowledge to express themselves. It’s up to the designer and developers to understand what the user really needs and how to best give them what will actually work and not simply to recreate what the consumers says. And they can only develop solutions that deliver real results when they truly understand the user and the user’s needs and workflows.
Alerts & Prompts. Faster Horses, Worse Transportation
While it may seem counter-intuitive, healthcare software with alerts and prompts to guide users will actually put your agency at great risk for deficiencies in an audit.
The literature on this is replete with what is called: Alert Fatigue. Alert fatigue is when an overwhelming number of alerts desensitizes the users to the alerts and prompts leading to missed or ignored alerts or delayed responses.
According to a study in the Journal of the American Medical Informatics Association (JAMIA) regarding alerts in healthcare EHRs: “Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate.”
According to the study in the AACCN Journal of Advanced Critical Care: “Research has demonstrated that 72% to 99% of clinical alarms are false. The high number of false alarms has led to alarm fatigue. Alarm fatigue is sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms.”
For hospice software, desensitization to alerts and prompts which are intended to textually guide users to complete documentation in a manner that is timely and accurrate, has the counterinuitive effect of less complete, less accurate, and less timely documentation.
Similar to the traffic sign in the example above, rather than creating a clean visual workflow that intuitively guides users to, many software systems try to fix already cumbersome workflows by putting up more and more signs. And while in a guided demo the account executive skim past these issues while touting the benefits of their many alerts and prompts, in the real world of day to day application for nurses who are desperately trying to document information in between patient visits, or a medical director who simply needs to sign off on their IDG narrative, alerts and prompts slow down and interrupt their workflows. Desensitization and frustration with textual based alerts and prompts coupled with cumbersome workflows leads to slower time to documentation, less comprehensive and less personal documentation, a build-up of unfinished and unsigned documentation and more.
Simply put, alerts & prompts create a greater audit risk for your agency because your users are struggling with cumbersome software.
Better Design for Better Workflows
A guiding principle of design can be found in the quote often attributed to Leonardo da Vinci: “Simplicity is the ultimate sophistication.”
Hospice Tools CTO Gary Stern lays out his 4 design principles:
- Know the problem. All software strives to solve some problem (even if the goal is just to make a working solution even better). If you don’t know what problem you’re trying to solve, you will never be able to design a great solution.
- Know the user. When you know your potential users, you can anticipate their needs/questions/concerns in advance. Part of knowing your users is to know their industry from their perspectives and how they will use your software. Be sure to ensure clean, readable design for all device types and layouts.
- KISS. Simplicity is the key to great software! Use recognizable design elements and patterns to make users instantly comfortable and familiar with the environment. If you need a user manual, your software may be too complicated. Manuals are great for reference, but if a user can’t figure out basic function and navigation without one, you’re probably doing something wrong. Take a step back and try to simplify.
- Don’t be a nanny! Give the user flexibility to find their own way and define their own workflow wherever possible. Alerts and popups are a game of diminishing returns: the more you have them, the less effective and more disruptive they become. Make use of validation to protect the user from themselves and make sure that the data integrity is maintained.
Hospice Tools has taken the modern approach to hospice & palliative EHR/EMR design. Create workflows that are easy to navigate and intuitively match clinician’s workflows with key documentation fields requiring validation for final submission.
By understanding the user, the industry, and their problems Hospice Tools delivers a solution that enables clinicians to chart and manage their charting simpler & faster.
As they say, the proof is in the pudding. Recent reports on EHRs note that most clinicians spend over 50% of their time on clinical documentation. This is a MASSIVE FAILURE created by cumbersome legacy tech and consultant-based workflows. Clinicians using Hospice Tools cut that time by about HALF spending approx. 27% of their time on clinical documentation. When clinicians can manage their charting faster and more effectively, not only can they spend more time on patient care and less time in front of a computer screen and it also means when an auditor walks in, the documentation is complete.
Or as one auditor told an admin of a Hospice Tools client, “I wish all the [hospice] agencies used Hospice Tools. It’s so clean and simple and easy to navigate. Everything is where and how it should be and just makes the whole process simple.” FYI, the client had a ZERO deficiency on their audit. (References & demos of Hospice Tools Audit Mode available privately upon request)
Hospice Admin Challenge. Compare two teams for a month, one using a typical cumbersome legacy EMR with their workflows replete with all the alerts and prompts and at the same time give another team Hospice Tools. At the end of the month compare the metrics: which team has more complete and timely documentation, which solution allows doctors to bulk sign documents from their phone, which solution allows you to easily customize forms to adapt to your workflows.
Unfortunately tests like these are not realistic because unlike Hospice Tools, other EMRs don’t provide free trials and want you to sign long term contracts that lock you in well before you discover that it’s 2 am and the talk button is next to the power button.
Hospice Tools is the powerful and affordable EMR built from the ground up for hospice & palliative agencies.
Get the EMR that delivers a competitive advantage & peace of mind with smooth operations, easy chart management, revenue management services and more!
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