Lessons Learned Using Rapid Human Factors Methods: Condensed Timeline with Effective and Impactful Results

Abstract

Contextual inquiry and discount usability represent a powerful combination of human factors methods as a responsive and rapid approach to better understand end users’ interactions with a new electronic health record (EHR) system as an enterprise capability. Contextual inquiry is an approach to conducting ethnographic field studies and discount usability is a simplified and efficient technique to identify usability issues. This paper describes how the Veterans Health Administration (VHA) Office of Health Informatics Human Factors Engineering (OHI HFE) responded to a request from VHA leadership to provide rapid support to assess EHR post-implementation system performance to discover if there are barriers or shortcomings. The team utilized contextual inquiry methods and principles of discount usability to assess system usability and effectiveness in meeting end-user needs. OHI and the Electronic Health Record Modernization Integration Office (OEHRM IO) formed a team to conduct semi-structured interviews and observations with health care providers at a VHA facility to gather qualitative data showcasing representative users’ experiences with the EHR. The team analyzed the data collected to identify themes and created an affinity map and two service blueprints. It then used this information to produce a report of findings and recommendations. The study identified areas that required remediation, actions that would facilitate success, and opportunities for improvement. Key contributors to the success of this rapid and important effort included the team’s ability to accommodate a compressed schedule by carefully targeting scope; focusing on a smaller number of participants than originally planned; asking direct, targeted questions developed in advance; and capturing data during short interview and observation windows. The data collected also highlights opportunities to continue the use of discount usability methods, when necessary, to continuously improve OHI HFE data collection and achieve targeted quality improvement in a condensed timeframe.