Many doctors continue to use hard-to-share paper charts and files. An electronic health record (EHR) lets doctors access medical histories, prescriptions, lab results and other vital information about their patients online--which enables better care.
Alberta's Physician Office System Program (POSP) plays a key role in the move toward electronic health records in Alberta by helping doctors purchase new computers and software for their offices. POSP is a complicated program; it provides up to four years of funding for computers and EHR software provided doctors meet certain performance targets. It also requires a significant investment of time and energy on the part of doctors and their staff.
In 2005, POSP came to us for advice on their website. They needed to improve their sign-up process, and make the website more effective at supporting doctors as they moved through the program. We helped them re-architect their website, simplify and focuse their content, and gave them a deeper understanding of doctors' experiences implementing EHR systems.
nForm conducted telephone interviews and site visits with physicians to understand their office environments and the challenges they face introducing computers, networks and new software into their existing processes.
While many doctors wanted the benefits of electronic health records, they found the technology requirements confusing and the sign-up process difficult. Nurses, medical receptionists and other office staff were found to be key stakeholders who used the electronic health record systems as much or more than the physicians.
And while EHR vendors promoted time savings and efficiency as the main benefits of an electronic health record, we found that most doctors spent more time inputting data into their EHR than they did with paper charts. The real benefit of an EHR was improved care, especially for patients with chronic illnesses like diabetes.
Finally, we found that word-of-mouth was the most effective tool for getting doctors interested in the program.
Based on our discussions with doctors and their staff, we developed a conceptual model that matched user goals with program milestones and website content.
We focused on helping doctors move through each stage of the program--from interest to application to implementation--easily and successfully. The strategy also involved connecting doctors to support services that could ease their transition to electronic record keeping--as long as they accessed them at the right time.
Architecture, Prototyping and Evaluation
We then turned the strategy into site blueprints. A task-focused site architecture was created, and we used a staged disclosure model to reveal content only when it was relevant to a doctor's task.
A complete mock-up of the site was created on paper and taken out to another group of physicians for usability testing. This testing validated our main assumptions and helped refine the overall design and architecture of the site.
This project generated three main outcomes:
- A new, user-focused site architecture for POSP that helped them meet their recruitment goals (with visual design and implementation by our friends Yellow Pencil)
- A better understanding of doctors' difficulties with the sign-up requirements, especially online
- A set of metrics to connect website performance to POSP's business goals.