2006 EHR WfMS Tutorial Slides 36-41: EMR EHR Usability Principles and Workflow: Relevance

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From Chapter 7: Natural Language Processing, Business Process Management, and Adaptive Case Management in Healthcare in How Knowledge Workers Get Things Done: Real-World Adaptive Case Management:

Relevance means the EHR doesn’t provide too much information or too many options. I first encountered “relevance” as a formal cognitive science notion in a book called Relevance (1986, MIT Press) by Sperber and Wilson. A reviewer described is as “one of the most important and influential books of the decade.” The Principle of Relevance is this (concentrate now!): ‘any utterance addressed to someone automatically conveys the presumption of its own optimal relevance.’

Of what possible, ahem, relevance could this have to EHR workflow and usability? Well, if an EHR shows a screen to a user, the user is not unreasonable to assume that it’s relevant to some task relevant to a goal. The goal might be taking care of an acutely sick child, conducting a camp physical, or perhaps, in one of many visits, tuning asthma meds. One way to make EHRs and HIT systems more relevant, on a screen-by-screen basis, is to use workflow definitions. Who, what, why, when, and where context information can drive which screens, data, and order entry options are pushed to which users. That’s the Business Process Management. And if a user cancels, postpones, or forwards a task, that’s the Adaptive Case Management.

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Relevance

  • “having a bearing or connection with the subject at issue”
  • “how pertinent, connected, or applicable something is to a given matter. A thing is relevant if it serves as a means to a given purpose”
  • From Wiki from Hjorland and Sejer: “Something (A) is relevant to task (T) if it increases the likelihood of accomplishing the goal (G), which is implied by T”
  • S & W: “any utterance addressed to someone automatically conveys the presumption of its own relevance”

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Bicycle Controls (Relevancy>

Having to enter a combination into a combination lock in order to shift gears? Seems pretty irrelevant to me! (Actually, It’s kind of hard to think of something irrelevant on purpose, our minds aren’t wired that way. We look for patterns and are reminded of whatever is relevant to our purposes at hand.)

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Lots of Irrelevant Buttons!

Here, what I did was, turn on every toolbar in Word. Wow! What a confusing wall of options, which as my point. Compare that with WordPad. A long time ago I was asked to teach an introduction to computing and wordprocessing. I aways started with WordPad. A lot simpler. A lot less scary. The relevant principle here is Hick’s Law: competing targets slow down hitting the correct target.

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EMR EHR Relevance

  • Is user input (clicks!) and system output minimum necessary?
  • Are navigation paths short?
  • Does output reflect audience?
  • Does EHR calculate or deduce data from other data already in the system.
  • Example: Dosage calculated from weight

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Relevant EMR EHR Picklists

In this example, the use selected the diagnosis Pneumonia. They expected, and got, a list of relevant drugs. Seems obvious now, but remember I developed these slides in the around 2005. Lots of EHRs as late as then still required users to search through thousands of medication options to find the right ones, instead of the system automatically offering the most relevant medications.

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Relevant Workflow

  • Degree of elimination of extraneous information and options
  • Too much information can be as bad as not enough!
  • User role: related sets of activities, responsibilities, and skills
  • Process definitions use roles to select screens, content, and behavior

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Related links:

EHR/EMR Usability: Natural, Consistent, Relevant, Supportive, Flexible Workflow

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