Human Computer Interaction (HCI) principles and how these can be applied to EHR design

Human Computer Interaction (HCI) is the description of the relationship between the information system and the users. Starting with the earliest forms using plain text, HCI has evolved to the traditional Graphical User Interface (GUI), and now the goal is a more transparent interface³.

There are several basic principles which should be incorporated in designing a user interface: an understanding of the business, effective graphic elements, an approach from the user perspective and a focus on usability, use of models and prototypes during the process along with iterative feedback and comprehensive documentation.  In designing the interface, among the basic rules are to create a transparent interface using familiar terms and images. Also, the interface should provide an easy way for the user to get help.  An effective user interface design should enhance productivity and provide feedback all in an attractive package ³. As Acharaya stated, “...to achieve dependable, usable, and well-engineered interactive devices in healthcare requires applied Human Computer Interaction (HCI) research and awareness of HCI issues throughout the lifecycle, from design through to procurement, training and use”¹.

In a health care environment, the HCI takes on a more important role to ensure no adverse incidents are attributed to software or devices due to inadequate user interface design. HCI in healthcare is not different from HCI in other industries, but if not given a high enough priority, quality and other issues traced to poor HCI may persist¹. Loss of productivity during training is a big concern, and better interface design will cut down on training.  “Usability has a strong, often direct relationship with clinical productivity, error rate, user fatigue and user satisfaction–critical factors for EMR adoption” (HIMSS, 2009). Also, providers may not be able to compare EHR systems as effectively if they are not made with common HCI interactive standards².

To achieve more effective EHR utilization, the UI should be predictable and allow the providers to focus on the patient cares. In a medical environment, there may be a need to follow tradition to ensure patient safety and proper system usage.  As also noted by HIMSS², good UI design should incorporate a familiar, natural flow, and be consistent and predictable. Natural Colors can be used to consistently convey meaning.  Red should be used for warnings, stop, exit, alerts, and emergencies such as a drug interaction alert.  Yellow should be used for caution, mild warnings, or issues that require attention such as a lab result with mixed results. Green should be used to convey ‘go’, or to ‘proceed safely’, or all OK such as lab results that are normal. Blue should be used to convey cold, or advisory conditions. To accommodate users that are color blind, these should be accompanied with a secondary identifier that is also used consistently².

Another way for a UI to be more effective in health care is to match the pace of physicians. Health care providers may be very mobile, and focusing on and talking to patients. They may not be able to give full attention to the software and thus need a system designed around their workflow.  To achieve better EHR adoption, the UI should minimize the number of steps it takes to perform any function, and also be free of clutter and minimize any ‘computer’ or ‘technical terminology².

To go a bit further, designers may need to think out of the box to anticipate user perceptions and future actions and steps users may take. For instance, users in a traditional client-server app will expect to left click a mouse on a note to open and begin documenting, but will they also use the EHR on a tablet and expect a touch screen command, and will that conflict with another action? Training and support can do only so much –if health care providers are learning charting a certain way, the EHR design should keep an eye on that format and adapt current applications.

References:

1  Acharya, C, Thimbleby, H, Oladimeji, P. (2010). Human Computer Interaction and medical devices. Electronic workshops in computing (eWIC). The Chartered Institute for IT. Retrieved September 29, 2013 from http://ewic.bcs.org/upload/pdf/ewic_hci10_paper19.pdf
2  HIMSS (2009). Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating. HIMSS EHR Usability Task Force.  Retrieved September 29, 2013 from: http://www.himss.org/files/HIMSSorg/content/files/himss_definingandtestingemrusability.pdf
3  Shelly, G. & Rosenblatt, H. (2012). Systems analysis and design, ninth edition (9th ed.) Boston: Course Technology Cengage Learning.