We live our lives half in reality and half in myth. Ancient archetypes reverberate through us with as much frequency and impact as physical jolt of our feet on the ground, propelling us forward. For some the archetype that resonates the most with them is the jester, for others the sage. For some it is the innocent, for others the outlaw. For those whose feet hit the ground in the hospitals, clinics, and exam rooms of every type the world over, it is the caregiver’s archetype that lights their daily steps.
Care givers have been around for as long as groups of humans banded together in family and tribe and they will always be an integral part of society. They help us understand our own bodies and the ways that the experience of life affects it. Some help us heal a wound, some help us understand our own consciousness, and some help us accept our own mortality. For many, a caregiver’s hands are the first and last that touch us, guiding us from one fundamental phase of life to another. When many physicians receive their medical degree, they recite the oath of Maimonides. Part of it states “May I never see in the patient anything but a fellow creature in pain.”
We all have multiple relationships with technology. There is technology we use in our professional life, and there is technology we use in our personal life. There are affordances we easily make in one realm that we struggle with in the other. It is difficult to ignore the speed at which technology is transforming how we all live and work. I often wonder if technological change always felt like it was moving faster than most people’s equilibrium could handle. Did that first mechanical thresher or loom feel as breathtaking and unnerving to those working in agriculture or textiles as those changes driven by the digitization of healthcare? It is impossible to ignore the speed of change taking place in the relationship between clinicians, their patients, and the provision and consumption of healthcare driven by the increasing inclusion of microprocessors and Moore’s Law across the continuum of care.
In the latest episode of HIMSS’ Innovation that Sticks podcast, we have an opportunity to gain the perspectives of three clinicians who are playing critical roles in ensuring that during this time of tremendous transformation taking place in the healing arts, the importance of the clinical users’ experience is considered when designing the technologies they use to care for all of us. Recorded on-site at HIMSS15, these three clinicians, a nurse and two physicians, discuss what drew them to the topic of user experience and why they are so passionate about it and its importance to their ability to deliver care. Three clinicians whose hearts drive them to care for other clinician’s experiences as much as they care for their own patients’ health.
Nancy Staggers PhD, RN, FAAN brings a wide range of experiences to her practice as a nurse researcher and HIT consultant, with an extensive background across operational IT projects and, more recently, academe. Innovation That Stick’s Ethan Baron asked her what first brought her attention to the clinician user experience. “I started out in EHR implementations,” Nancy says, “and I quickly realized that user experience, especially a good user experience was paramount to IT, to excellent adoption rates. Early on in the systems, it was clear that workflow and the way clinicians think didn’t fit the way we were designing systems”. You can hear the same concern in her voice as she describes the current state of user experience in the healthcare industry she would have when caring for a sick patient. “In this nation, right now I’d say we have a crisis in user experience…for both safety… as well as productivity. You hear both of those echoed in the physician community. Nurses have been quieter, but it doesn’t mean they have any fewer issues with technology…Usability and UX improvements have a correlation to reducing costs and improving labor productivity. For nurses for example, one nurse was telling me just yesterday, it takes her 30 minutes and 500 clicks to chart a patient assessment and that isn’t an overly complex one that’s the average that she does. I know we can do better than that.”
Dr. David Schlossman is a passionate advocate for the importance of user-centered design and its principle’s effect on the clinician experience with health IT. A medical oncologist by training, he talks with Ethan about the experience that drove him ultimately back to school to earn a Master’s in medical informatics while maintaining a practice of caring for those of us dealing with the “emperor of all maladies”. You can hear the emotion in David’s voice as he describes the moment when he realized the importance of user experience. “After we implemented an EHR and CPOE at my hospital, it became my passion to try to help optimize these systems and also to accelerate their evolution into a new generation that was optimized to support clinical workflow and give us the tools we needed to take better care of our patients rather than just aggregate data and report it for financial and administrative purposes.” For David, user experience is integral in meeting the goals of so many current efforts to make our care delivery system more effective and efficient. “If we are going to improve the quality of patient care and the cost efficiency of patient care this first off depends on helping our physicians make the best clinical decisions that they possibly can. And if we are going to make good clinical decisions we have to get the right information to the right person in the right format in the right point in the workflow to make the good decisions. We can use (these tools like) clinical decision support…bring(ing) the patient’s immediate clinical information and the scientific information from medical literature together in the same screens, in the same workflow, and then that incentivizes and makes it easy for us to follow best practices and best pathways, decrease practice variance, and then produce better outcomes in the populations we take care of.. UX is very challenging, but it is a key component. If you have all the functionality in the world, it doesn’t do any good if people can’t use it. Medicine is a sociotechnical system and we have to support the thought process and care process at the bedside, otherwise our triple aim of better care, better population health, and lower cost is never going to come to be.”
Jeff Belden, MD, is a family physician whose interest in user experience happened pretty early on. “I got interested in user experience a number of years ago trying to use a DOS PC compared to a Macintosh, and saw that there was a big difference when the user experience is designed for the user.” During Jeff’s interview, he touches on the mental model of being that highlights uniqueness of the clinician experience. “Software developers don’t think like the users, physicians or nurses, because they can’t. They’re not the same people. So when you can understand and empathize with the user, whether it is a physician or nurse…you can make their work more effective for them.” He admits there are challenges in communicating the clinician experience. “Working with clinicians is a challenge. They are busy and it is hard the get them to sit down long enough to talk. One of my roles is to recruit my colleagues to them to sit down long enough to give us feedback.” He sees reasons for hope as IT continues to evolve healthcare. “We are developing a common vocabulary…now with this emerging common vocabulary that we have “user experience, observation, field research, usability testing, iteration, sketch and iterate, as we learn what those terms mean together then it will be easier for vendors to find collaborators from the user world to collaborate with.”
These three clinicians, part of the global tribe of care givers who see those that are sick say “there is a fellow creature in pain” and reach out their hand. Let’s make sure when these heroes reach out a hand to their IT, we reach back with that same sense of calling.