Leveraging Interactivity, Plain Language, and User-Centered Design in the Development of an EHR Usability Change Package

Background:

Although many tools and resources exist to assist health care practices as they address usability concerns with their electronic health records (EHRs), the resources are often complex to navigate and find.

Program background:

To support individual practices and hospital environments with limited resources or experience as they make necessary usability-related improvements to their EHR systems, the Office of the National Coordinator for Health IT funded development of an “EHR Usability Change Package (UCP).”

Evaluation Methods and Results:

The UCP was developed in an iterative fashion with the assistance of staff at four testing sites and a technical expert panel (TEP) of representatives from the federal government, usability experts and consultants, health systems, professional societies, universities, and the vendor community.

Stages of development included (1) identifying candidate resources, (2) making a wire frame mock-up of how these resources would be presented, (3) adapting the resources to the interactive PDF format, and (4) conducting several rounds of testing (with the TEP and at test sites) and refining content and design based on input (via semi-structured interviews and surveys) from users representative of health care organizations and clinics that could benefit from the tool.

Our team collaborated to develop a delivery method for the EHR usability resources and ways to improve access to these resources in a single unifying document. Because we had developed interactive PDF toolkits, we proposed that an interactive PDF would be an ideal format for the low resource target audience because it can be used on desktops or tablets without affecting its design. It is designed for accessibility and is Section 508-compliant across devices.

Principles of website design guided the creation of the 56-page PDF. It includes navigation and interactive tools that enhance usability and guide readers to parts of the document relevant to their needs. In the spirit of user-centered design, hyperlinks, buttons, and banners make the document easy to navigate.

Rounds of testing revealed that users had difficulty with navigation and with our initial structuring of sections. This informed a restructuring that mirrored how users approach solving an EHR problem.

The editor and graphic designer worked together to apply Plain Language principles throughout the document. After each round of TEP revisions, the editor re-worked any complex jargon and reevaluated each section of the document for clarity and consistency. Each round of TEP revision, in turn, informed the editors approach to language use and helped to determine the organization of key sections and subjects. This iterative process helped to ensure that the language was appropriate for the rather wide audience, and that the interplay between words and graphic elements worked to improve the reader’s understanding.

Conclusions:

The interactive features make use of the UCP more intuitive and seamless for the user and the ability to print out the UCP helps ensure that practices with different abilities and access can still benefit from the materials.

Implications for research and/or practice:

Discussion of future work on this UCP identified advantages of a more interactive community-sourced product that incorporates feedback received from those who use it.