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HIT Implementation Strategies and User-Centered Design

Synopsis: HIT teams need to adopt UCD and UX
techniques if they hope to improve project outcomes.


HIT teams are typically quite large because they include representatives from all of the departments within the end-user community. These individuals play a very important role: to ensure that clinical systems will be useable and useful when implemented. Ideally, design and configuration of a clinical system, like any other system, should be centered on the optimum user experience (UX) using user-centered design (UCD) principles.


Unfortunately, many sources site issues with usability as a tremendous barrier to the success and adoption of computer systems by clinicians and other end-users. The AMA and the federal government agree that a user-centered design and usability requirements are critical when creating clinical systems, but are generally lacking in the existing systems. In an attempt to remedy the situation, the Health Information Management Systems Society (HIMSS) has created an HIT User Experience Community to help try to refocus HIT development efforts with clinical end-users in mind. But applying UDC principles is a very ambitious endeavor that will require foresight as much as it will require collaboration.


Even within the context of implementing a vendor’s EHR system (which by definition has already been “designed”), there are certain UX basics that can and should be applied during the design and configuration phases of the project implementation. User research concepts need to be fully explored and addressed with the clinical team members and the vendor in order to incorporate as many of the usability requirements as possible into the software, workflows and end-user devices. Therefore, all HIT team members need to be familiar with UX and UCD, and the importance of these concepts to the success of the project.


Realistically, UX is more of a process than an achievable goal. The fields of Ergonomics, Human Factors, and User Centered Design are not exact sciences. Furthermore, not all users agree on what a system should do and how it should do it. And when a vendor product is being installed, certain requirements are not within the power of the HIT implementation team (such as whether the software can run on multiple browsers and operating systems). There are, however, usually great opportunities to incorporate UX concepts during the software customization process (i.e., streamline and reconfigure pathways, reorganize information, utilize hyperlinks, create custom reports, choosing and configuring devices, etc.), and these ideas can be triggered using brainstorming sessions and use cases. These tools and techniques are taught in any quality HIT education program.


Once the UX requirements have been identified and prioritized by the end-user team members, a well-trained and thoughtful technical team that includes vendor resources can try to come up with the best options for meeting those requirements. This trial-and-error process can be exciting as well as frustrating – the tools and techniques often involve questioning and prototyping in order to get the creative juices flowing. Ultimate success, which benefits healthcare organizations and patients alike, is a matter of balancing creativity with realism and solid understanding of technical capabilities – and possessing a crystal ball comes in handy, too!