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user needs within a health care setting. In addition to following existing general design
guidelines such as Microsoft Common User Access, Windows User Interface, Nielsen Norman
Group, human factors best practices, and releases from user interface (UI) and usability
professional organizations, many vendors consult with Web sites, blogs, and professional
organizations related to health IT to keep up to date with specific industry trends. Supplementing
these outside resources, many vendors are actively developing internal documentation as their
products grow and mature, with several reporting organized efforts to create internal
documentation supporting product-specific standards and best practices that can be applied
through future product updates and releases.
Industry Collaboration
As these standards and best practices are being developed, they are not being
disseminated throughout the industry. Vendors receive some information through professional
organizations and conferences, but they would like to see a stronger push toward an independent
body, either governmental or research based, to establish some of these standards. The
independent body would be required, as all
vendors reported usability as a key
competitive differentiator for their product;
this creates a strong disincentive for industry-
wide collaboration. While all were eager to
take advantage of any resources commonly
applied across the industry, few were
comfortable with sharing their internally developed designs or best practices for fear of losing a
major component of their product’s competitiveness. Some vendors did report they collaborate
informally within the health IT industry, particularly through professional societies, trade
conferences, and serving on committees. For example, several vendors mentioned participation
in the Electronic Health Record Association (EHRA), sponsored by the Healthcare Information
and Management Systems Society (HIMSS), but noted that the focus of this group is on clinical
vocabulary modeling rather than the usability of EHRs. Some interviewees expressed a desire to
collaborate on standards issues that impact usability and patient safety through independent
venues such as government or research agencies.
Customization
In addition to the initial design and development process, vendors commonly work with
end users to customize or configure specific parts of the EHR. Vendors differed in the extent to
which they allowed and facilitated customization and noted the potential for introducing errors
when customization is pursued. Most customizations involve setting security rules based on roles
within a clinic and the creation of document
templates that fit a clinic’s specific workflow. Many
vendors view this process as a critical step toward a
successful implementation and try to assist users to
an extent in developing these items. While some
vendors track these customizations as insight for
future product design, they do not view the customizations as something that can be generalized
to their entire user base, as so many are context specific. The level of customization varies
“The field is competitive so there is little sharing of
best practices in the community. The industry
should not look toward vendors to create these best
practices. Other entities must step up and define
[them] and let the industry adapt.”
“You cannot possibly adapt technology to
everyone’s workflow. You must provide the
most optimum way of doing something
which [users] can adapt.”