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Clever Trumps Sincere in HCIT Usability

March 19, 2013
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There’s been a lot of progress at many levels in the last year on the usability front. They include regulatory (2014 edition of Meaningful Use certification), user Interface attention and innovations, emerging centrality of mobile and speech recognition, and whole new ways to break the fixed mental mindset around getting work done.


At HIMSS earlier this month, there were 26 highly instructive presentations on the topic of usability. Arguably the best was Dr. Jeff Belden’s outstanding presentation, “Medication List Makeover: Usable lists for the task at hand.” The take home points are here, and they complement my related discussion and take home points on workflow and analysis of Medication Reconciliation here.

The other standout wonderful presentation on usability during the past year was Dr. Ann Bisantz’s “Cognitive Engineering for Health IT,” presented at Johns Hopkins in June 2012. Click here to see the video.


One of the important distinctions that Dr. Bisantz calls out is the separate, but overlapping disciplines of: 


1.   Human Factors (broader term that encompasses humans as part of the system),

2.   Cognitive Engineering (work demands on the individual humans), and

3.   Usability (interface design, typically at task level).


I’ve written extensively on the cognitive dimensions in HCIT in my Blind Spots blog series in which I present predictable biases and errors that have been well studied and have distinct safety, quality and cost implications. You can read each installment by visiting this page and clicking your choices. 





Dr. Bormel,
Very "clever" post you have here. I learned something very important as my hospital adopted ever-increasing technology for what has become our EHR.

It was quite a long time before I was able to do anything clever with our system. At first, I resisted the technology to continue embracing a paper process. As it became clear I had no choice but to changes my ways, I begrudgingly began using the system, fighting it all the way. But this simply compounded my use of the software. I was searching to its weaknesses in order to slow its adoption. I was wrong.

After accepting the fact that change was the order of the day, I decided to go with the flow and find time to learn all I could about how to use the system. It wasn't really all that long before I came up with a few "clever" ways to use it that I shared with my peers.

Today, I'm fully engaged in supporting not only the use of our system, but its further evolution. I'm a senior member of our IT decision making group, and regularly consult directly with our vendor-partner that I once considered an adersary.

My point here is that existing systems are better than they may appear on the surface. The main problem is 100 percent acceptance by physicians. I realized that the level of acceptance is much better these days, but even in my own organization there remain a few vocal detractors. And I've learned it doesn't take many critics to severely impact full implementation in spite of increased regulation and MU. This is a tragic mistake for both hospitals and their patients.

Have you found this to be true during your visits to facilities nationwide? I should think its rather common. Of course, I've now become one of those tech advocates who is asking our vendor to speed up the evolution of our system! Keep up the good work.

Doc Benjamin

Doc Benjamin, Thanks for your kind words and sharihng your experience. Most organizations (Eligible Hospitals and Providers) figured out how to achieve Stage 1, with varying amounts of time, resources and goals to get there. I'm optimistic about Stage 2, as were most of those I spoke with at HIMSS. It sounds like you are as well. Usability and Interoperability are clearly getting a lot of attention, much of it clever.

Great post, Joe! Usability was among the hotter topics at HIMSS13!

Your readers can access the handout to Dr. Belden's presentation (174) here:

In April, a recording of his session (as well as more than 200 sessions) will be available for purchase in the HIMSS eLearning Academy:

Rob Oakes
Manager, Distance Education

Thanks Rob.

For folks who haven't used the eLA in recent years, it's a terrific resource. In my experience, attending sessions virtually is outstanding, and often the only option.

I can usually find at least a half dozen complementary sessions on the topics I'm looking for. The experience of the presenters is always candid, honest and based on the real world. This dimension is never adequately captured in the pdfs alone. For example, last year, we were working on enhancements to our clinical inbox functionality. eLA gave me immediate access to the latest thinking, functionality and safety issues surrounding this rapidly evolving dimension of EHRs and HIEs. The Canadian Coach eSafety task force presentation in 2012, for example, was outstanding, both pdf and linked audio.

The audio recordings are available, linked to the slides, so that the audience experience is completely preserved.

The search function works well and archive goes back enough years that I've never searched a term that did bring back presentations of interest.

For healthcare executives and managers with a "Learner" strength, eLA is a must.

Thanks again Rob, for all you do!

Thank you for kind words, Joe! We're very excited that we can help bring this content to the industry!

Great post Joe. I have been using the ambulatory EMR for 2 years and from very early on I started using the technique of documenting the history including pertinent ROS in the HPI section and then in the ROS section selecting negative except HPI. It is a time saver. I don't think being clever rules out being sincere. We are all trying to take care of patients and charts at the same time, and in order to give the patient the time he or she needs, we are forced to find the short cuts that allow us to adequately document the chart without compromising the patient experience.

Thanks for the kind words.

When I was introduced to the importance of making a distinction, the word "sincere" was meant to imply "not clever", when a clever solution was known to exist.

In the spirit of excellent coaching, calling out sincerity as a strength is vitally important. Asking the person being coached subsequent questions, usually in the form of holding up a mirror to them with the "Sincere" approach, can be an effective way to create a productive conversation.

I agree that some situations, often termed predicaments rather than problems, are only amenable to "sincere", dedicated, focused work on the part of professionals. "Clever" alternatives are part of a larger topic of learning, experimentation, and improvement. As called out in length in the outstanding aforementioned book, Switch, finding the clever bright spots is the only effective way to manage through some challenging problems.

Thanks for your comment.