Integrating human-centered design into health IT workflows

The digitization of healthcare has not been uniformly easy, with ongoing concerns about the usability of technology in the real-world care setting. Human-centered design can help smooth this transformation.

Poorly configured workflows in electronic health records (EHRs), practice management systems, and other complementary health IT tools are a perennial complaint for healthcare staff members and have been strongly implicated in rising levels of burnout among clinicians and administrative professionals.

Fortunately, many health IT systems are highly customizable, and solutions vendors are making them even more so as they heed feedback from their partners across the industry. A new generation of technology is now emerging that prioritizes user-friendly workflows and simplified, streamlined interfaces to ease the cognitive burdens of working with technology tools for hours each day.

Healthcare organizations that want to take their technology optimization one step further should consider the role of human-centered design (HCD) in architecting processes for their clinical and non-clinical staff.

What is human-centered design?

Human-centered design isn’t just about making technology easier to click through. It considers the entire context in which the technology is embedded and takes a broader view of how humans interact with technology to complete a specific task, whether or not that task takes place in front of the keyboard.

This distinction is important, especially as healthcare becomes increasingly mobile, collaborative and patient centered. Health IT infrastructure must meet the needs of a variety of different users in different settings while keeping patients at the center of the care process.

According to the International Standards Organization (ISO), human-centered design for interactive systems must meet six key criteria:

• The design should be based upon an explicit understanding of users, tasks, and the environments in which they function
• Users must be involved throughout the design and development process
• The design team accepts and integrates user-centered evaluation of design factors
• The process is iterative and continually validated
• The design of the system addresses the whole user experience
• The design team incorporates multidisciplinary skills and perspectives throughout the process

Applying human-centered design to a health IT optimization project

In the healthcare environment, deploying these principles depends on developing a thorough understanding of the organization and its needs and recruiting the right influential stakeholders to secure buy-in and provide crucial input on upgrades and changes.

While many organizations may focus first on the EHR, it’s important to have a clear idea of how changes to the EHR workflow will affect other systems and functionalities, such as coding and billing, clinical analytics, patient engagement and regulatory reporting.

To successfully adapt workflows without causing a negative chain reaction across the enterprise, organizational leaders should consider the following steps.

Ask the right questions to solve the right problems

People aren’t machines, and they don’t behave like robots. They make mistakes, lean on workarounds and get set in their ways. Taking these factors into account is crucial when developing the right questions to ask about organizational problems.

For example, asking, ‘how can we ensure that everyone starts adhering to this specific workflow we have in place?’ may not be as effective as asking, ‘how can we best achieve the desired outcome using all the tools and skills we have on hand?’

The first question simply focuses on creating uniformity throughout a process without reexamining the utility of that sequence, while the second focuses on solving the ultimate problem, whatever that may be.

Asking more outcomes-based questions can help identify the real pain points in existing processes so teams can creatively address barriers and holistically develop workable solutions.

Avoid designing in a vacuum

Human-centered design is a collaborative effort that must involve multiple stakeholders with unique experiences and viewpoints.

Direct users of the technology should be involved from the very beginning of the process, since they are the ones who are often most invested in increasing efficiency and reducing frustrations.

In the early days of the electronic health record, vendors rarely took advantage of clinical input during the design process, and end-users suffered accordingly. Now, physicians, nurses, and other clinicians are regularly consulted about workflows, leading to much more intuitive and usable digital tools.

Individual organizations should take a similar approach. Consider identifying clinical champions – both physicians and nurses—who can represent their colleagues during optimization efforts.  Give users ample opportunity to test new processes before a full roll-out, and ensure that all users are educated about when, why, and how their technology is going to change.

Take staff feedback seriously and make decisions accordingly. A failed implementation will erode trust and increase resistance to future changes, so be certain to carefully and deliberately unveil new processes alongside regular opportunities for staff to provide input.

Identify the right metrics for success to iterate quickly and collaboratively

Human-centered design teams never stop asking questions, even after an adjustment has been made. That’s because a healthcare organization is a living, breathing entity that changes over time, and processes need to adapt accordingly.

Optimization leaders should generate a clear idea of what constitutes success and establish a regular cadence of reviews to ensure that the workflow in question still meets those criteria in six months, one year, two years, and beyond.

If the technology has fallen out of alignment with the organization’s changing needs and goals, it’s time to iterate once again. Take the same amount of care during iterative improvements as was devoted to the original design project.  Incorporate as many perspectives as needed to get an accurate gauge of the problem and the solution and provide the same amount of staff education as at any other step in the process.

Dedicating time, effort resources to human-centered design can significantly enhance existing health IT tools while ensuring that users can easily interact with digital infrastructure.

By taking an organized, collaborative, and iterative approach to optimizing health IT tools, organizations can achieve their clinical goals, avoid burnout among staff, and create better experiences for providers delivering exceptional care to patients.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.