Stop twiddling your EMR MFC knob and opt for usability

Pioneer 8200BT 

I recently compulsively changed my Pioneer audio deck for one that could interface better with my iPhone. As technology evolves, a deck that handled my iPod could not interact with the newer iPhone. Unfortunately, I ignored the usability issues I had learned from the last car deck upgrade by focusing instead on the feature set. How often do we do the same when selecting an Electronic Medical Record system?

My current EMR navigation is like the Multi-Function Controller (MFC) knob on my new Pioneer car deck; it is loaded with many features but fails in the context in which it needs to be used on a daily basis. 

On a new audio deck, you want to switch between radio pre-set stations, your iPhone playlists or CD with just a very quick glance at the deck so you can concentrate on the important task of driving safely. When the audio deck relies on an MFC knob, this gets too complicated and requires too much concentration. Clicking the knob upward, just to see a list that says preset 1, preset 2…preset 6 (none of which even say what station they are), then needing to rotate the MFC to highlight the correct pre-set. Then, if you haven’t already driven your car off the road, you have to try to see if the correct pre-set station is highlighted (only a very subtle difference in intensity) then push the knob in. Of course, with the car moving, you inevitably click the knob to one side or the other instead and end up switching to Auxiliary input instead of your station of choice.

With my current EMR, the steps seem just as convoluted as using the MFC on my audio deck. While examining a patient, I need to check the findings from previous visits for a specific part of the exam. I see a scar on the cornea and inflammation in the anterior chamber on today’s visit. Did this patient have these findings on previous visits? I move the current visit’s exam form off to the side of my computer screen (or to a second monitor) then click on the EMR icon in the side panel, find the Virtual Chart tab, click on that, visually scan to see which line on the spreadsheet is from the prior visit, then double click to view. Basically the equivalent of pressing a button on the audio deck, rotating to the correct date, clicking the knob to view it, and risking clicking on the wrong entry. Scanning through that form, I can at last see the findings from the previous visit. What about other prior visits? Same thing, basically turning a knob to highlight the correct pre-set, then pressing the knob, in this case double-clicking, just to get what I was looking for.

My EMR has most of the functionality but was clearly not well designed from a user’s perspective. The company did get a lot of input from physicians as to what features they needed in an EMR and those providing this feedback probably were very happy that the features they needed were getting added, perhaps ignoring the usability aspects. It is quite possible too that their clients did not know that there could be a simpler way of doing these things. There is a trade-off between feature set and functionality. In this case, my current EMR is excellent when it comes to customizing the history and physical on-screen form, but by the very nature of this design, this makes it harder to easily access all prior visits with one preset.

What would a usable solution look like for an audio deck? It would have less knob twiddling, clicking and pushing up, down, left or right. It sounds tedious the more I write about it. The solution for a car audio deck includes more real buttons or virtual buttons on a screen that give one touch access to whichever feature are needed depending on what mode you are in. These buttons should also be in the same position regardless of what deck mode you are in. For example, whether listening to AM, FM, Satellite, CD, iPod, memory stick, you know exactly where you need to interact with the deck to adjust the EQ or select a different track or station.

TeckSoft EyeVu IOP history

The solution for an EMR is analogous: less knob twiddling! When checking the cornea or other findings during today’s office visit, just click a history button on today’s encounter note within the cornea section you are currently entering data into. Boom - ALL prior cornea finding from previous visits are revealed. No knob click to the side to get to the EMR view, no rotating the knob until prior visit is highlighted, no double clicking the knob to open the prior encounter then rotating the knob until you find the cornea section. After all that, you just see one prior visit, not all prior visits. Better usability is a single preset button in each section of the encounter form that reveals all prior findings for that part of the exam. That is efficient and gets you the data when you need it without turning your knob!

This usability exists today and offered by many other vendors. So, when selecting an EMR for your practice, don’t just look at the feature set. It is vital that you think things through as to how you want to access your prior data. Never rely on a vendor showing you all the features; you have to try in your office setting before you buy.

How am resolving these woes? My audio deck solution is that I went back to FutureShop to swap the deck within their 30 day exchange policy. The new deck will have more physical buttons as well as a touch screen interface on a deck twice the height so that it allows for room to easily navigate while keeping my eyes on the road. For the EMR, I am evaluating two eye specific solutions as opposed to the medical specialist EMR I currently use. My current EMR is really excellent and can be made to work and is still ideal for most doctors (Accuro by Optimed Software) but Tecksoft’s EyeVu and Ifa Systems EMR have the preset button that makes it very easy to see the results of prior visits.

I’ll keep you posted!