Beyond the Electronic Health Record: Human-Centered Design to Reduce Clinicians’ Cognitive Burden

The article Death by a Thousand Clicks: Where Electronic Health Records Went Wrong is a joint investigation by Fortune and Kaiser Health News that looks “inside a digital revolution gone wrong.”

This sobering read exposes systemic issues in the design of healthcare technology. It shows how and why it has become too common to produce software that may meet certain functional requirements so we can “check the box,” but ignores the usability and the experience that the clinician will have using that software.

My big takeaway is that it’s not enough for developers to just produce a feature and show that it is working. Technology developers have hidden behind “it works as designed” and this is the very essence of the problem. Whether you’re doing work related to electronic health records, or producing alarm notifications, or enabling a person to make a phone call in critical circumstances, “it works” is not enough. The standard must be, “it works consistently in an efficient, safe, and reliable manner.”

Enabling technology to work consistently in an efficient, safe, and reliable manner is not so much about the features as it is about the experience. This is why it is critical for people who are designing and building technology to be connected with the people who are using it.

A Human-Centered Design Approach

At Vocera, we have embraced a more human-centered design approach to bringing solutions to market. We begin with problem statements and invest time to interview potential users and make sure we understand the problems we should be solving and why. We then share potential approaches with our user community and incorporate their feedback throughout the engineering process.

This approach enables better technology and an improved experience for users. And it helps ensure we’re solving the critical problems in healthcare like reducing clinicians’ cognitive load.

Letting Users Guide Product Design

We use this human-centered design approach in developing our technology’s experience-related functions. For example, in planning an upcoming software release, we began with the problem of nurses’ and physicians’ communication-related tasks.

Before writing any code, we spent more than six months interviewing customers and conducting focus groups. We created three different designs based on customers’ input, each using a completely different approach. We asked the customers who provided input to select the approach they liked best and moved forward with what they chose.

We refined the design elements over multiple iterations and built a working prototype. Then we went back to several different user communities and asked them to use it and share feedback with us. This was all long before we finalized the design.

The User Community Knows What It Needs

The limiting factor in creating software using a human-centered design process is the availability of potential users who want to take part in such a design process. There is generally more demand to develop and release new functionality than there is availability of people to have the necessary conversations.

Perhaps the dynamic between software developer and end user is something we should revisit together? I acknowledge that clinicians lead busy lives and really don’t have time to take part in such an exercise. Clinicians might say, “It’s not my job to tell you how to build your product, I’m here to care for patients.” Perhaps if we could forge closer relationships, together we might influence care team well-being and patient care for the better.

As the Fortune article about electronic health records makes clear, the process for determining how something should function and validating that it works for users is something that we, as an industry, find too easy to set aside because of the pressure to get things done. We can never lull ourselves into a false belief that we know what the user community needs.

I anticipate the technology industry will transition to a point where bad user experience is no longer acceptable. The user experience will need to be more of a focus as we go out into the marketplace to try and provide solutions for our customers.

I’d like to know what you think of the ideas advanced in the Fortune article. I welcome you to reach out to me on LinkedIn.