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Usability: What EHR Vendors Can Learn from the Gaming Industry

By Alex Tate, CureMD
March 10, 2016

As an industry, healthcare can definitely learn a thing or two from the finance and retail sectors as far as keeping costs low while providing the highest quality services. When it comes to electronic health records in particular, there is yet another industry that vendors can learn from, and that’s the gaming industry.

As someone who has young nieces and nephews who are addicted to video games, I often find I know much more about gaming than anyone my age should. Part of that knowledge comes from doing research on a particular game so I will have a clue what the kids are talking about when I visit.

For instance, their dad recently got them Halo 3, a game he himself has been hooked on since college. Knowing nothing about it, I did some digging online and saw an article in WIRED magazine called “Halo 3: How Microsoft Labs Invented a New Science of Play.” In reading the article I couldn’t help but think, “If only EHR vendors went to this much trouble, the tech “solutions” would be much more user friendly and intuitive.

Microsoft Analyzed 600 Gamers

To ensure they were creating the best game for their end users, Microsoft hired a doctor of experimental psychology to head up the testing lab, which was fitted with video cameras, a one-way mirror, and wired controllers so that every single moment would be digitally recorded.

Once the lab was all set up, they analyzed over 3,000 hours of play by more than 600 gamers. If you’re an EHR vendor – read that last sentence again. Through this intense testing, and by using heat maps, they were able to find snags in the game that stopped users in their tracks.

For instance, you want your game to be challenging, but Microsoft determined that some of their challenges (like lava pits and powerful mutant aliens) were a bit too challenging. The researchers also used pop-up one-question surveys to find out just how engaged or frustrated players were in any given moment.

Why Aren’t EHR Vendors Doing This?

Why is it that something created solely for entertainment purposes is tested, tested and retested; and yet a piece of technology that has been developed to help doctors help their patients gets little to no testing? Shouldn’t EHR vendors have a way to identify when providers get frustrated with their user interface?

The sad reality is that most EHR vendors aren’t even participating in user testing. According toa 2015 JAMA study, EHR vendors are even failing on the user testing that is required by federal design rules.

The study found a whopping 18% did not have a public report of usability testing on file with the Office of the National Coordinator for Health Information Technology. Of the 41% of the vendors who did file usability reports, only about one third said what type of user-centered design process they used. Even more startling (read alarming) was the fact that 63% engaged fewer than 15 participants in end-user testing. Hmm, let’s see… over 600 gamers VS less than 15 EHR users.

Another 17% of vendors admitted they didn’t even have physician on their testing team.

Though ONC has stated user-centered design processes and testing must be applied to a dozen primary EHR capabilities, often vendors don’t involve clinicians in the beginning phases of development. How can workflows possibly be designed with end-users in mind, if they don’t get any feedback until the main system has already been developed? Answer – they can’t.

What Needs to Happen

Luckily, enough clinicians have begun to complain about the technology they rely on to stay compliant and more and more vendors are now tracking clinicians’ experience as they use their systems.

But more needs to happen STAT.

So, what can EHR vendors and providers learn from the gaming industry to improve their health tech solutions? And more importantly, what can key stakeholders do?

1) Beyond actually performing the tests and including clinicians as part of the group, vendors should consider using eye-tracking software and other user-testing technology to see where their users hit snags. Though they won’t find lava pits and powerful aliens are the problem, they may find certain screens or drop down menus are.

2) Hospitals and health systems must also get in “the game” and make sure clinicians have plenty of training so they can adapt to imperfect technology. No physician can learn a new EHR in one sitting.

3) Providers must also do more than complain to their vendors about poor usability, they’ve got to encourage adoption and offer feedback, as well as volunteer for future testing seminars. 

Imagine what could happen to the healthcare landscape if EHR vendors began to take end-user friendliness more seriously. While we may not see vendors hiring doctors of experimental psychology to head heavily-fitted testing labs, the fact is, EHR vendors can and should be doing more to take their systems to the next level. After all, if hours of testing go into an entertaining game, shouldn’t the same, if not more, go into a piece of technology that can help save lives?

Author Bio:

Alex Tate is a health IT Consultant at CureMD who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance.


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