Usability: "is a term used to denote the ease with which people can employ a particular tool or other human-made object in order to achieve a particular goal. Usability can also refer to the principles behind an object's perceived efficiency or elegance. In computer science, usability often refers to the elegance and clarity with which the interaction with a computer program is designed."
No advanced software can be developed in vitro even by so-called experts. Instead, software programs such as Electronic Medical Records require years of feedback from active users; ideally many users over many years.
Only a few companies such as Praxis Electronic Medical Records have had two decades of experience developing EMRs while receiving feedback from hundreds of physician users. Others may state a theoretical know-how of what should constitute a superior EMR, but most EMR companies, having been in the market for an average of five years, lack the critical missing link: long term feedback from physicians using the product on a daily basis.
A major fallacy today is the belief that usability can be scientifically engineered into an EMR. It follows that really great software programmers will develop a really great EMR that is usable to clinicians and office staff, right out of the box. Over the last five to ten years, millions of dollars have been spent by large Healthcare IT companies—some quite respected—attempting to scientifically engineer EMRs, only to experience complete rejection in the marketplace. Indeed, there is no better test of usability than long term learning from actual users and properly interpreting thousands of critiques and wonderful ideas from those same users.
Over the years developing Praxis EMR, we have been constantly humbled by what we don't know. Clients provide us with constant evaluation and feedback as they use Praxis, some of which is no less than genius. Indeed, within Praxis EMR, our physician end-users and their medical staff have always acted as co-developers.
We know, for example, that the major issue in usability of software is “noise.”
Noise can be defined by the following formula:
NOISE = DATA – INFORMATION
Or, put a different way:
INFORMATION = DATA – NOISE
Data is everything the user sees on the computer screen at a given time, while Information is only that part of the Data that is useful to the user at the moment of making a decision. Everything else is noise, and simply should not be there.
Fascinating studies in cognitive psychology over the last 50 years have discovered a great deal about visual perception. It turns out that it is the fovea of the eye, a very small sector of the entire visual field, that actually “sees”. The fovea sector fixates on a specific small visual area for only milliseconds as it interprets it. A few milliseconds later, the fovea jumps to a nearby area in a mechanism known as “saccade,” and the process repeats. The eye performs this process of saccades to nearby fixations subconsciously hundreds of times a minute. It has been found that areas not fixated on by the fovea are literally not seen.
Thus, perception is not a passive act as was once believed. The subconscious mind directs the eyes to fixate on the contiguous areas to be interpreted. As an example, it constantly searches for meaning (information) in written text as it tries to avoid noise. A measure of usability then consists in only showing exactly what is needed, exactly when it is needed, and exactly where on the page it is expected. The less searching on the screen, the faster one reads, and the less tired one gets.
As one fascinating example, watch this funny video from the "Transport of London." It makes the point loud and clear!
Thus, usability is the art of reducing noise to a minimum, something that cannot be known a priori. What is considered noise to one user may be information to another. Every human reads differently, thinks differently, understands differently, and places different emphasis on reality.
In this regard, the problem with templates is that they force a user to follow a structured boilerplate created by someone else. Not only will the content and menus contain text not relevant to the user, but the very process of understanding someone else’s writing; the choice of words used, the positioning of phrases, all take time and effort, causing fatigue and stress. For example, even if all the “important” clinical descriptors are present in a given template, the lack of personal familiarity with the external text generates unnecessary effort on any provider.
In short: Templates are noisy by design.
The Concept Processor in Praxis EMR elegantly resolves the noise problem inherent in templates. All needed information is found exactly where the same user placed it last time and precisely in the user’s chosen words, thus making each subsequent note generation easier and faster. In essence, one can think of Praxis as an extension of the physician’s mind. Praxis simply displays one’s own thoughts, exactly when and where they are needed, and speeds up data entry, helping doctors write, and think, faster. With Praxis one charts as fast as one thinks.
We humans do not think with words, to say nothing of letters. We think in abstract concepts for which our brain automatically extracts the right words from our subconscious memory. Any physician who is dictating a medical report at 3 o’clock in the morning knows exactly what we mean. The words appear to come out of nowhere to express thoughts instantly. It is this second stage of expression that is replicated by Praxis, and where the Concept Processor comes to the rescue of the busy clinician.
If one made a mistake charting on a previous patient, and the error is caught on the current patient, then the same mistake can never be made in the future with any other patient. Thus, random human errors continually decrease as doctors practice better medicine and increase the speed of documentation.
Datum is a new Praxis EMR technology that enhances this process by embedding discrete data within free text, exactly where it is needed, and exactly in the format preferred. Datum even performs automatic calculations when required (e.g., instantly calculating the correct Body Mass Index (BMI) from a patient’s height and weight and automatically placing it within the note).
The computer learns exactly the same way humans do-by experience from previous similar cases. And, because each provider is unique, so is each Praxis knowledge base. Each provider creates his or her own knowledge base in the process of practicing medicine, consistently improving the speed of documentation with each additional case.
Over twenty years, hundreds of brilliant providers have taught us how to make Praxis EMR better, easier, and more powerful, and how to make the Concept Processor a truly wonderful clinical tool.
This invaluable feedback cannot be scientifically engineered or developed overnight. Usability is measured by efficiency and elegance and is only achieved by carefully listening to long-term clients and asking the right questions.
This is what makes Praxis unique!
Praxis is akin to the practice of medicine itself; knowledge from medical texts will never compare to the experience of learning from previous patients. Usability is the same. Listening to our many wonderful clients over many years has made Praxis EMR the most usable EHR software today.
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