Annotated slides from IxD13 talk Healthcare IT is one of the fastest growing fields in technology, but it has been around since the late 1960's. One of the first systems built was the electronic health record (EHR), which stores all information pertaining to a patient. Doctors can pull general information such as allergies and immunizations as well as documentation of specific visits the patient has had. EHRs were meant to reduce the time doctors spent on finishing their notes on their appointments in a paperless and easy fashion, but the usability of the systems discouraged physicians so much that the US lags far behind its European counterparts in adopting the technology. So when companies began to build mobile EHR applications, the big question was and still is: are mobile applications fixing the problem with EHRs? Health on the Go: Designing Electronic Health Records for Mobile, is a quick look at the common design problems that had to be solved in the EHR apps my team and I have built. I'll dive into what an EHR is and why it's important to the function of a medical practice, why the user is not just a doctor, the current state of mobile EHR design, and the three kinds of design problems in the space: designing for mobile, translating from desktop to mobile, and the restrictions on design from healthcare laws around patient privacy and safety. It's an introduction to what designing for healthcare can mean and how important user centered design is in this field because of the impact on patients' lives.

1. Health on the Go: Designing
Electronic Healthcare Records
for Mobile
Sweta Mohapatra
@smohapa3
Thursday, February 7, 13
A few months ago, I decided to go back to my dermatologist in Illinois from my college days because I didn't want to look for someone new in Raleigh. What I saw there was that the practice,
which is this new and very nice facility, was using paper charts. There were all these modern features, but the nurse and my doctor were handwriting all their notes.

2. The History of the EHR
First developed in the late 60’s
Unpopular through the next two
decades due to usability issues -
US falls behind European
counterparts in adopting the
technology (<20% in US vs 80%
in western Europe)
US Government developed
programs to encourage use of
certified EHRs
Obama Administration -
HITECH
Image Source: http://www.ehrmarket.com/blog/2009/02/
Thursday, February 7, 13
- EHRs first built in 1960s
- Goal: standard and automated method to document
- Benefits (hypothetical) - paperless documentation, easy to use, saved time. Lost due to usability issues
- Doctors rejected it from 70’s to 90’s
- Government incentives - HITECH but doesn’t solve key design problems

3. Who is the
User?
Location Roles
Private
Hospitals Doctors Nurses
Practices
IT Services Administrators
Specializations
Tasks Workflows
Thursday, February 7, 13
- Hospitals vs Private Practices
- Scale
- Departments
- Urgent vs non urgent
- Similar tasks but different workflows
- Roles
- Doctors: chief complaint, physical exam, assessment and orders
- Nurses: initial assessments, noting, vitals
- IT services: configuration
- Administrators: check in, billing, etc
- Specializations
- Primary care vs dermatology. Different focuses that alter key tasks

4. Patient Safety and Privacy
Porting from Desktop
Designing Mobile EHRs
Thursday, February 7, 13
With the users of the mobile EHR in mind, what is the set of design problems? These are the three overarching types of design problems that I've encountered in this space: designing EHRs
for mobile, reconciling desktop with mobile, and finally patient safety and privacy.
New EHR:
- Consistency in interaction patterns
- Different form factors
- Established mobile patterns (iOS, Android)
- Tasks
- Ability to complete tasks without resorting to base system
- Rule of thumb: 20/80 - within the feature set, users use about 20% of it 80% of the time. Defining that 20% requires a lot of research into each user role so that when we build the
mobile version, we provide a viable experience without overloading the user with too many functions.

5. 20/80 functionality rule
Fixing workflows from base
system
Fixing workflows from base
system
More screen space != more Interaction consistency
features
Thursday, February 7, 13
Building a mobile EHR based on an existing system is much more complex - in addition to the design problems new mobile EHRs have, we rely on the desktop's workflow to drive the mobile
design and the ability to change the desktop experience is unknown. What if we found a way to fix a usability problem from the base system? It's easy to say 'Sure, let's do the right thing and
fix it,' but as the fixes add up you end up with an entirely different product. This forces the user to have two mental mappings for the same tool - one for the desktop and another for mobile.
On the other hand, usability in this industry is driven by click metrics. The more clicks it takes to do something, the less providers like it. In all the usability studies I’ve conducted, every
physician has been concerned with the number of clicks it takes to perform a task. So if we add a few more buttons and screens to accommodate the desktop workflow, the doctors give
negative feedback about too many clicks. Where do we draw the line in what we fix as mobile designers? That's a question that we're still trying to find the answer to.

6. Patient Privacy
and Safety
Thursday, February 7, 13
Rule of healthcare: DON’T KILL THE PATIENT. EVER. JUST DON’T.
- Drug allergy checks
- Key checkpoints
- Orders/medications are created
- Provider signs off on note at the end of visit and orders are sent to be filled
- Patient privacy
- HIPAA
- Medical and billing info protected by doctor and everyone who helps with practice’s services
- Existing solutions: two factor authentication, session timer

7. Where Do We Go
From Here?
Thursday, February 7, 13
Where do we go from here?
- Meaningful Use
- Stage II - user centered design process
- Usability test, but easily manipulated
- Stage III - predicted that requirements will include more tools to document UCD process followed
- Personas
- Extensive user testing
- Importance for designers? Need to define standards and explain to stakeholders the importance of UCD. Move away from click based metrics and more to corrective practices
- Research
- Optimizing workflows
- Fixing existing EHRs - might be more of an internal process to start with
- Understanding mobile’s role in healthcare

8. Thank You!
Thursday, February 7, 13
HOORAY!