HMS recently announced to our customers the launch of the Patient Logic suite of enterprise clinical and financial systems. A key consideration for Patient Logic products is an unwavering commitment to workflow and visual design. The user experience with Patient Logic products is shaped by four fundamental design principles. In this and my next three posts, I will take you inside our design process.

There are four fundamental design considerations for Patient Logic:

• Fierce reduction of clutter (this post)
• Content, not chrome
• Visual perception
• Clarity

Hospitals are busy and full of interruptions competing for attention. For the work of clinicians, anything non-essential to reviewing patient status, planning care or performing interventions is not only poor design, it is dangerous. Thus, our first design principle is to reduce clutter.

Reducing clutter refers to eliminating screen elements unrelated to patient information or decision making. Every item is on a screen because someone, whether that person is a physician on our advisory board or a product designer, has successfully defended its purpose.

Perhaps surprisingly, a relatively small subset of patient information is required to quickly access the state of a patient. By reducing clutter, we are able to present the patient chart so that abnormal and critical items are immediately recognizable. Access to additional information is never more than one tap or click away. Non-urgent information is displayed, but does not compete with important information for the clinician’s attention.

Reducing visual clutter doesn’t end with data presentation. We scrutinize every workflow in the same manner. As a result, Patient Logic products bring information to you when and where you need it. For example, when customers asked to copy lab results from the chart into a note, we thought that was a cluttered workflow. In Patient Logic, it is one tap to view the lab results, another tap to indicate the results you want in your note, and the user then can comment on the values.

No screen flipping. No cut and paste. No remembering what values you want to add to your note.

We didn’t end our drive with visual design and workflow. Even our software architecture and implementations follow this pattern. We constantly refactor our software to simplify and remove sources of confusion. This allows us to rapidly respond to change. Look for additional posts explaining how Patient Logic design principles are changing the way people view an EHR.

Doctors are inherently creatures of habit and are trained in pattern recognition. Physicians follow set protocols, algorithms, pneumonics and are very astute in patterns such as an EKG, EEG, arterial wave forms, flow loop diagrams, etc. During a patient encounter, physicians follow a set pattern religiously. The pattern consists of reviewing data, documenting and then placing orders. It is essential they believe that EHRs will further simplify this ritual.

Step 1- Data Review. The first thing physicians do before seeing a patient is a quick data review. A good EHR user interface should consist of a compilation of pertinent and relevant data for that encounter. This data should be presented in a centralized place with the appropriate headings. Physicians are looking for a “push” of data instead of the MD having to “pull” the data for review. An example in the paper world is where labs and current medication administration have been placed on the chart. With the development of technology and information exchange; we now have the ability to consolidate information and push it to the end user. In turn, this will allow the physician to assimilate data quickly and prepare for the encounter.

Step 2- Documentation. Documentation or writing a note is an obvious and important step for physicians. Documenting quantifies your data, exam findings, impressions and recommendations. It validates that you were there. It is not only important from a legal standpoint but also important for appropriate reimbursement. Physicians follow certain data collection patterns based on a specific encounter such as taking a History and Physical or documenting a SOAP note. EH’s create the opportunity to pre-populate important data entry and facilitate an easier way to document my patient plan.

Eventually, as EHR data collection increases, systems will become more intuitive and the majority of a physician note will be completed for them. EHRs will deliver common documentation elements such as vitals, labs, problem list, home meds, allergies, directly into a note thus saving time. Additionally, higher reimbursement generally follows more thorough documentation.

Step 3-Order Entry. Order entry is by far the most important piece of a physician’s day. It is how we apply our vast array of knowledge and treat our patients. The physician order is equivalent to a conductor leading an orchestra through Mozart’s Requiem in D minor. The physician order starts the plan in motion and includes numerous moving parts. CPOE streamlines these orders by distributing them to the appropriate department for execution. Computer order entry helps eliminate handwriting errors, filter medications through contraindications and provide decision support, to name a few benefits.

If we can simplify this pattern for physicians by focusing on these three events; the industry will improve the physician’s primary activities and will begin to design user-centered software.

As hospitals transition from paper to electronic health records, they are working in what is commonly referred to as a hybrid environment: a combination of paper, EHR and document imaging.

A complete electronic health record allows users to create, store, organize, edit and retrieve patient records on the computer. Additionally, certain products enable hospital users to bring paper records into the EHR and reduce the need to revert to printing even when signatures are required. These products help users bridge the transition from the world of paper records into the complete electronic environment.

A document imaging solution captures paper generated within the facility or received from outside the facility and brings it into the EHR. In addition, electronic signature with scanning capability enables physicians to easily sign both electronic and hardcopy documents. This capability saves physicians time by eliminating a physician’s visit to the HIM department to sign hardcopy documents.

Further, intelligent forms allow a facility to obtain signatures from a patient as well as other information and then archive the completed form without the need to print. Any intelligent form that requires physician signature can be automatically routed to the digital patient record. This time-saving step improves efficiency by eliminating the process of printing the form, scanning the document and then routing it the physician for electronic signature. Workflow improvements like these help physicians see the value of electronic health records and experience the benefits of their use.

Acute care hospitals and physician offices must have EHR systems in place and attest to using them according to federal guidelines by the end of 2014 and 2015 to demonstrate meaningful use, earn meaningful use stimulus funds, and avoid CMS penalties. For hospitals working in the “hybrid environment,” effective use of tools like these will make a major difference in achieving those goals.

Educating and empowering patients to take control of their health has been a mantra of nursing for many years. As we evolve into a healthcare setting encompassed by technology, it is becoming necessary that clinicians also educate and empower patients to utilize tools that allow them to take control of their personal health information.

Recently the American Nursing Association, in collaboration with the U.S. Department of Health and Human Services’ (HHS’) Office of the National Coordinator (ONC) for Health Information Technology’s Consumer Campaign, released a request for nurses to pledge “ to involve and empower consumers in their health management through the use of information technology” (ANA, 2012). The idea of this pledge is to encourage the use of information technology by nurses so they learn how to read, review and maintain their own health records online and therefore are able to assist and encourage patients to do the same. The ANA will be obtaining and reviewing innovative methods and tools, such as patient portals, submitted by nurses over the next few months and sharing with the ONC the most efficient strategies for facilitating adoption of more consumer-centric health information technology.

Patient advocacy has long been a primary focus for nursing. As healthcare technology evolves, we now have a new opportunity for advocacy as we focus on helping patients seek and understand their own health information and empower them to take action through effective use of information technology. Initiating this effort requires clinicians to first evaluate their methods for reviewing and editing their own personal health records, and then determine what methods they feel would be beneficial for their patients.

As clinicians, it is no longer enough that we lead by example in our health regimens. We must also empower and educate patients in utilizing information technology through leadership and advocacy. We must all practice what we teach, not only in health practices but also in health information technology utilization.

Follow the ANA updates at:
www.nursingworld.org

Take the Pledge at:
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/ONC-Consumer-Campaign-Pledge.html

Read more on how the software described here, commonly known as patient portals, will benefit hospitals.

I walked into a department store last weekend and immediately was greeted by one of the store representatives, welcoming me to the store. I nodded, and as I strolled past, she asked me if there was anything in particular I was looking for. I told her that I wanted to look at men’s shirts, and she not only pointed to where that department was, but actually walked me over there. During the brief walk, she told me how the store had just remodeled, making the aisles a little wider, displaying the marquis more prominently and reorganizing the departments in a more “logical” sense. In the end, I bought two new shirts and a tie. Moreover, I was impressed with just how pleasant my shopping experience was.

When you log on to a software application, why would you not expect this same kind of experience? You’re not looking for men’s shirts, or shoes to go with your new outfit, but you are “shopping” for a convenient, pleasing and easy way to get your job done.

As a software vendor, HMS strives to make your “shopping” experience as pleasant, yet effective, as it can be. Whether you are a physician documenting a patient’s current symptoms; a clerk registering a patient; a lab tech verifying a critical result; a central supply director verifying a vendor order; a nurse entering vital signs; or a CFO reviewing the hospital’s P & L report, you want to quickly and easily get to what you want, when you want it, as effectively and accurately as possible.

How do we make that happen?

One way is through the work of our User Experience (UEX) Team, whose job is just that—determining how to give our customers and partners the best experience when using HMS applications. The primary purpose of the UEX team is to design products around the needs and wants of the user, to design workflows and remove unnecessary visual clutter. The ultimate goal for future products is to make the software ‘disappear’ by making the needed data the focal point.

While the UEX team has designated members, we are all “extended members” of that team. Additionally, the whole Product Development staff routinely performs competitive analysis, conducts customer advisory group and focus panel meetings, reads and implements user requests and solicits suggestions from not only our clients, but other industry and non-industry experts.

All these methods share the same goal—to give the HMS user the best “shopping” experience we possibly can!

As a practicing physician, I am keenly aware that other physicians enter the world of electronic health records with a sense of caution and optimism. The majority of physicians just want to take care of patients and deliver quality, evidence-based healthcare. The ever-evolving landscape and bureaucracy that is the business of healthcare is wearing on providers as a whole. There is nothing like the thrill of piecing together information and arriving at a spot-on diagnosis. What we dislike is jumping through hoops for documentation and justifying payment for the services rendered.

Today, there is a bi-modal distribution of doctors in the US. You have a large sub-set of older docs that hate the new game and every aspect of how it is played, but they are forced to adapt because they are too far along their career path to do otherwise. On the other hand, you have young, technology-savvy MDs who grew up in this technology-driven age and see the current healthcare game as the norm. They have far too much time and money invested in their education to not play the game within the rules of engagement.

Regardless, of which end of the spectrum the physician may be on, one thing holds true: today’s healthcare is a game, and HRs play an integral part in it , exposing patient data across multiple mediums that will enable physicians to transcend the prior patient experience. The EHR will allow providers to make informed decisions based on transferable and factual archived patient histories. Information exchange makes perfectly good sense. It is something the banking industry figured out in the 90s, so why so long in healthcare? In theory, having the ability to transmit patient data universally will simplify the provider’s pathway to that spot-on diagnosis. In reality, creating a data-exchange platform that is easy to navigate and can capture real-time information is quite a challenge.

With meaningful use timelines and the natural evolution of EHRs, physicians are being tasked to use these systems as they are developed and while data entry is ongoing. This makes for a steep learning curve in a world where time is money and quality outcomes count. As a practicing doc, all I want to do is see patients and get paid fairly for an honest day’s work. In order to do this, I need to learn how to play the EHR game.

I’ve written several posts outlining how we engage customers in our development process. In this post, I will present an example of this in practice.

From the product development perspective, medication ordering is a particularly interesting workflow. This is a complex process by nature; we don’t want our solution to add complexity. One of the more challenging questions is, “What information regarding current orders does a physician need to effectively manage medications?”

We initially approached this like most vendors; we displayed lots of information to avoid forcing users to “click” to find details. Internally, we debated the necessary key information, goals of a physician reviewing current medication orders, and what actions a physician would likely want to take.

We were left with two divergent approaches, both grounded in solid arguments. One approach displayed a maximum amount of information to avoid clicks. A second approach emphasized minimal information with quick access to order details on demand.

Fortunately for us, we have a physician advisory board comprised of both HMS customers and physicians who use other systems. We developed four variations for viewing current medications orders. At an on-site meeting, we presented these four options and asked each physician to individually rank their preferred visualization.

Two solutions rose to the top. We facilitated a discussion about preferences, focusing on perceived differing needs. During this discussion, the physicians shared variations in practice, patient conditions, and most importantly, what needs unfold the vast majority of the time. The discussion ultimately moved the group to a clear consensus. With our physician advisory board in agreement, we have strong reason to believe our design will be usable, effective, and efficient.

Design decisions like this occur literally thousands of times during the development of each release or new product. Many are fairly clear (regulatory, HMS experience, existing design approaches). But when developing new workflows or improving existing workflows, early customer outreach is a key component to the HMS user-centered design approach.

If I were to ask you to name one of the most critical competencies for success in healthcare and healthcare IT, how would you answer? Technical aptitude? Deep clinical expertise? No doubt those are important, but the one I had in mind was actually lifelong learning. This skill is now recognized by educators, accreditation organizations, certification boards, and employers as one of the most important competencies that successful people can possess.

I’ve written previously about the dizzying pace of change we all face. Products change, software changes, processes and policies change, and so too do the needs of our businesses and the customers we serve. To keep up with all this change successfully, we must be able to adapt to it. And learning is a key component in developing that ability. Consider the importance of this attribute in recruitment. For healthcare leaders facing a multitude of changes on every front, it may be vital to choose lifelong learners when building teams that navigate major changes successfully.

Lifelong learning doesn’t require being permanently enrolled in classes or continually racking up qualifications. It’s more an attitude and set of behaviors that help us succeed. If you are choosing among several strong candidates to hire, how do you recognize a lifelong learner? Watch for these characteristics:

1. Lifelong learners realize that learning is a process that never ends. It is a way of continually improving, both professionally and personally.
2. Lifelong learners keep an open mind. When we think we know all there is to know about a topic or situation, it’s easy to miss or disregard new information because it conflicts with something previously learned. An open mind means we can benefit from any learning opportunity.
3. Lifelong learners are always curious. The question “why” is a basic and obvious sign of the desire to learn more. Instead of relying on others, they take charge of their learning, including goal-setting, acquisition of knowledge, self-assessment, and self-reflection.
4. Lifelong learners learn everywhere. They recognize that the classroom is not the only source of knowledge, and they manage a personal network of knowledge sources, including colleagues, books, Internet and social media, experimentation and even their own and others’ failures.
5. Lifelong learners help others learn. And they know that when they teach others they are not only helping the student, but also increasing their own mastery of the subject.

Do you recognize yourself and your team members in some of these? As you consider each of the characteristics, ask yourself how you and your team measure up, and commit to doing better. Set an example for others by following a blog or two on a topic of interest or strike up a conversation with someone whose knowledge or skills you admire, regardless of their position in the organization. It’s never too late to build a team of lifelong learners who face and conquer change with the success that all great organizations seek.

In nursing school I was trained in how to thoroughly assess a patient's pain in order to provide the best treatment. This involved questions such as, Where is your pain? When did it start? And maybe most importantly, Does your pain radiate or travel anywhere else in the body? While a patient may believe his or her problem is located at the precise point of the pain, the pain may be a symptom of a problem somewhere else.

As an informatics nurse specialist, I continue to use those skills to treat a much different kind of patient. Customers from all clinical backgrounds report kinks and catches within the system. Often the most valuable question is, Does this problem travel or radiate? While customers may be adamant that they know the source of a problem, it does not necessarily mean the problem didn’t originate elsewhere, or that it doesn't affect one or more other areas of the electronic health record (EHR).

While I want to find the quickest solution to a customer problem, I must also address its source and prevent other issues elsewhere in the chart. Although the customer may be seeking a fast fix, ( no one likes to deal with pain for any length of time) as an informatics nurse, I must make sure I'm not causing further problems by implementing a resolution without first weighing the pros and cons of each solution.

Treating the source of a problem is done in much the same manner it would be in a hospital--- through consulting a team of experts. Through collaboration and brainstorming, a team of web developers, user-experience designers and fellow product managers can help determine the best solution in the shortest amount of time, while minimizing the impact on the rest of the system. That approach provides "pain" relief and increases "patient" satisfaction. The ultimate goal is to get the user "logged in, logged out, and on their way" to better EHR health!