HIMSS11 ARRA Usability Symposium

Previously I discussed the problem I was having selecting a HIMSS11 pre-conference symposium in one of my more popular blog posts. Ultimately, I chose the ARRA Usability symposium. Having attended the symposium a week ago, I am happy to say that I was satisfied with my choice. The expert speakers were almost all entertaining. I'll review some of the highlights.


The session started with a talk by Dr. Charles Friedman from the Office of the National Coordinator. He presented the first of many iterations of the definition of usability we were to hear during the day. Using a picture to represent a thousand words, he showed an image of a concert pianist playing his instrument as a metaphor for the ideal for how people should interact with health IT computer systems. He also hinted that usability criteria are being considered for official inclusion in requirements for Meaningful Use stages 2 and 3. NIST is working on methods that may be incorporated in certification test scripts for EHRs that would result in pass/not pass on usability. Dr. Friedman set the stage for a segue into presentations focused on scientific testing tools utilized by NIST and regulatory oversight for medical devices by the FDA.


I have been impressed by the work provided by NIST to support certification of EHRs for Stage 1 Meaningful Use. NIST had only a short time to ramp up staffing and deliver on their enlarged responsibility. The two NIST speakers at the symposium provided assurance that concern about EHR usability is a priority at their organization. Many have wondered if/when the FDA will assert its authority concerning EHR software as a medical device so it was interesting to hear from the FDA at this conference. Ron Kaye (no relation!) spoke about FDA oversight of EHR technology. I was disappointed that he did not bring more clarity to issues such as: 1) FDA's role in assessing and assuring EHR safety, 2) how ONC and FDA reconcile their overlapping roles, and 3) why the FDA accepts vendor attestation of usability of their systems rather than requiring independent validation (it was made clear that the role of the FDA is not to "test.") That seems a little like having the fox guard the hen house. Perhaps that explains the new direction NIST is taking to objectively test EHR usability. Symposium planners included a talk about accessibility issues and EHR software. I suspect many of us don't stop to consider the challenges in usability faced by those with disabilities. We should always consider their needs when it comes to designing computer systems.


The final talk of the morning session was by Dr. Dean Sittig. His presentation was a candid, down-to-earth discussion of HIT usability factors, with relevant examples, that resonated with experienced EHR users. Many attendees headed to lunch, shaking their heads in agreement with the points made by Dr. Sittig. This reflected their own first hand experiences with the efficiency, effectiveness, and satisfaction (or not) with the use of EHR systems (usability.)


The highlight of the symposium was hands-down the series of case studies presented after lunch. This was a lively, multi-faceted collection of real-life stories that kept everyone entertained and thereby avoided the usual post-prandial slump. The speakers represented varied points-of-view. They each filled different organizational roles.


Overall, I was happy with my choice of symposia. An excellent bibliography was provided on usability that should prove useful in the future. I previously discussed some issues of EHR usability in 2009. I wish I had clones to attend some of the symposia I reviewed previously. I hope to cover those bases by listening to the recorded sessions offered by HIMSS when they become available in a few weeks.