Electronic Health Records Case Study
Conducting a Research Study on EHRs
OVERVIEWObjective
Our objective was to acquire a deep understanding of how patients and medical staff interact with electronic health records (EHRs), with a particular focus on interoperability, and to provide recommendations for improvement.
Outcome
My team conducted a research study, comprised of a field study and a survey, and translated insights and user feedback into actionable recommendations to enhance usability.
PROJECTWe conducted an in-depth research study to gain a thorough understanding of EHR users and their goals, challenges, and activities, including how each party accessed, modified, and shared information across multiple devices and platforms.
INFORole
UX Researcher
Team
2 UX Researchers
Myself
Responsibilities
In my team of three, I was responsible for conducting user research, including interviewing users, performing usability testing, and developing, distributing, and analyzing surveys. I also created journey maps and task flows.
THE PROCESS To gain a holistic, in-depth understanding of how users engage with EHRs, we used a two-part approach: a field study and a survey.
The field study was carried out in the following steps:
User interviews
Data analysis of individual users
Journey mapping and task flow creation
Data synthesis
Data analysis via affinity mapping
Survey
Analysis of survey results
FIELD STUDY PARTICIPANT RECRUITMENTWe conducted background research on EHRs to inform our selection of participants for interviews.
Because we wanted to understand the user experience for both practitioners and patients, we recruited three medical professionals and three patients who regularly engage with EHRs to participate in the field study
USER INTERVIEWSWe each conducted in-depth interviews with users to delve into their backgrounds, goals, and their interactions with their EHRs.
To structure our interviews, we devised a set of questions tailored to each user group. Subsequently, we carried out face-to-face interviews with six users, aiming to replicate their typical work environments as closely as possible. Following these interviews, we observed their natural interaction with EHRs, asking them to verbalize their actions and thought processes as they navigated the systems.
User profile details can be viewed here.
ANALYSISAfter conducting user interviews, we compiled and examined the significant insights gained from each user.
In the case of our physical therapist, Jenny, I pinpointed various inefficiencies and redundancies within the interface. These observations highlighted missed opportunities to streamline and enhance her documentation process with patients using the technology.
TASK FLOW + JOURNEY MAP DEVELOPMENTWe created task flows and journey maps to illustrate and crystallize our understanding of our users’ processes, goals, and pain points when using their EHR.
1
Integration of Paper and Electronic Records
The existing blend of paper and electronic patient records was inefficient. Implementing a cohesive digital workflow is imperative for increased efficiency.
In my analysis, I leveraged Jenny’s user journey to uncover the hurdles that physical therapists commonly face while interacting with their specific Electronic Health Record (EHR) platform. This approach helped us pinpoint areas ripe for enhancement.
2
Time Constraints on Note-taking
Limited time for note-taking highlights the necessity for enhanced automation. Implementing automated features would not only boost efficiency but also alleviate the burden of manual note-taking.
3
Optimization of UI
We recommend streamlining the EHR's user interface to simplify the completion of basic tasks. Furthermore, integrating visual cues for note status can enhance user experience, eliminating the need for manual verification.
The task flow I created depicts Jenny’s step-by-step process of engaging with her EHR platform, including interactions and note-taking procedures during patient care.
I created this journey map to illustrate Jenny’s daily routine as a physical therapist. It sheds light on the pain points and challenges she faces as she strives to create accurate and efficient notes while delivering patient care.
DATA SYNTHESISWe then synthesized our findings for each user and each user group by creating a user/task matrix.
AFFINITY MAPPING: KEY INSIGHTSWe systematically analyzed our findings using affinity mapping, identifying some key insights.
1
Users chose their platform based on a variety of needs, using apps on smartphones and tablets and web browsers on their work or personal laptops.
2
The primary reason patients used their EHRs was to access information.
3
Having access to technical support 24/7 was very important to most users.
4
Users found some EHR platforms too complicated (to the point of finding little value in them) and wanted something more simple and streamlined.
5
Some medical professionals felt relying too much on the EHR actually detrimentally affected their work.
We began by writing down each observation, finding, and idea from our interviews and sorting them into like groups.
We then refined the groups, crystallized our insights, and subsequently labeled each group as a category.
SURVEY DESIGNWe created a survey to learn more about how patients interact with their EHR patient portal.
We recognized that, while our user interviews provided valuable insights, they also sparked questions that would benefit from further exploration with a larger group of users to validate and expand our understanding of how users interacted with their EHR portals.
We defined our survey group to individuals over age 18 who use EHR patient portals to access their medical records via a website or mobile app.
Our survey objectives were to:
1
Discover the main reasons patients engage with their EHR patient portals and their goals when using them
2
Understand which features patients find the most and least valuable in their EHR patient portals
3
Identify underutilized features and opportunities for improvement
The central question our survey sought to answer:
How do patients utilize their EHR portal, and what factors and features most impact the way they interact with them?
SURVEY METHODOLOGYSURVEY RESULT ANALYSISAfter calculating the confidence intervals and analyzing the results of the 118 responses we received, we drew the following insights:
1
Most participants were women who were 25-34 years old.
2
Top area of use: viewing test results; tied for second place: scheduling appointments, sending/receiving messages, and viewing and/or paying bills.
3
Although scheduling appointments was one of the top user goals for EHR use, it was also frequently cited as one of the most difficult tasks to complete.
4
Somewhat surprisingly to us, most patients preferred to communicate with the doctor’s office via phone (perhaps due to EHR usability issues?), followed by email and direct messaging via EHR portal.
5
Nearly all users desired to receive automated reminders (ideally via text for most) about annual appointments, routine check-ups, etc.
6
Users wished that their portal integrated all their providers so that they could have all their health information in one place.
Some sample questions are below, and the full survey results can be viewed in the Survey Deck.
Users primarily used their EHR to view test results, schedule appointments, send/receive messages, and view and/or pay bills.
Almost all patients desired to receive automated reminders about annual appointments, routine check-ups, etc.
Having their portal be integrated across all their providers was the top thing users wanted that they currently did not have.
RECOMMENDATIONSBased on our findings from the field study and survey, we recommend EHR developers consider the following suggestions:
1
Include an onboarding feature via a product tour or hotspots to familiarize users with their portal.
2
Design for interoperability: users want their EHR portal to integrate with all their providers to allow them to use one unified platform for all health records.
3
Design for multiple devices: EHR patient portals must be accessible via application and web interfaces.
4
A reminders/notifications system using text messaging should be in place for portals that are not capable of sending out push notifications.
5
Allow patients multiple ways to log in since they may access EHR infrequently (e.g., via phone number associated code generator, as opposed to PI).
6
Include a medical terminology feature for patients to more easily understand diagnosis information.