CUA of the Month – June, 2007

Usability: Just what the doctor ordered

by June Oliver

The next time you visit your personal physician, you may have Christina Chang to thank for a shorter wait and more thorough treatment. Christina is a user experience specialist for Purkinje, a healthcare IT service and software provider created by doctors for doctors.

In contrast to the cutting-edge sophistication of most medical technology, medical records often linger in the “dark ages” of paper charts and handwritten prescriptions. Only a small percentage of U.S. physicians who work in solo or small group practices have made the leap from paper to electronic health records (EHR), despite efforts by hundreds of vendors. The reason: horror stories from early adopters about increased workloads, cumbersome applications, and even billing system dysfunctions.

Purkinje’s diagnosis: A usability deficiency. To treat the condition, Tom Doerr, Purkinje’s Chairman and Chief Medical Officer, brought in a usability expert.

“Dr. Doerr takes usability very seriously and understands the importance of institutionalizing it,” says Christina. “Also, our CEO Bryan Dieter expects every employee to go and visit our customers.”

Christina loves to meet Purkinje’s clients, despite the challenges of studying users in medical settings. “It’s difficult to do Contextual Inquiry in a clinic. We have to be very focused because doctors have extremely full schedules, plus we encounter all the patient privacy regulations. But we also talk with nurses, front office staff, and the people working in the labs. They enjoy having a chance to tell us what works in our products and what needs to improve.”

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Usability: Just what the doctor ordered (Continued)

Christina’s comfort in the medical environment developed during a four-year stint at Elsevier, a leading medical publisher. She worked there on the user interface design of MD Consult, a searchable on-line database of reference books, journals, practice guidelines, patient education materials and drug information for physicians.

“At Elsevier, I gained experience in user-centered design throughout the project life-cycle,” Christina says. “Even though I was a senior software engineer, expanding my skills into usability seemed like a natural step. Now at Purkinje, I work closely with our engineers but also serve as an advocate for our users. You have to listen to them.”

Christina has accomplished a phenomenal amount since she joined Purkinje in August 2006.

“At the time, we were preparing to release our main product CareSeries™,” she recalls. “It’s a very comprehensive software suite, including records of patient visits, test results, radiology reports, referrals, and scanned documents. CareSeries™ provides support for prescribing medications, checking drug interactions, and also handles scheduling and billing while generating administrative and financial reports. The software is customized to fit the needs of each practice. It even allows patients to access their personal records online or refill a prescription.”

Considering the scope of the product, it isn’t surprising that CareSeries™ contains 1600 screens. Christina’s first responsibility at Purkinje was to redesign, well, all of them.

“I was able to jump right into the user interface redesign project from day one, thanks to our VP of Engineering Mark Balbes. He is a great executive champion for usability,” says Christina.

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Usability: Just what the doctor ordered (Continued)

She worked closely with Purkinje’s marketing and product management teams to develop a UI style guide and design standards for CareSeries™. With these tools, the redesign was implemented in just a few months with the help of 45 developers in Purkinje’s Hyderabad office. The new version launched in February 2007 and was recently judged to be the best ePrescribing system in the U.S. market at this year's TEPR conference (Toward the Electronic Patient Record).

“When we introduced CareSeries™ at a trade show in Washington, D.C., many clients remarked it had the best user interface they had ever seen in an EHR product,” says Christina. “Since then, customers have told us that CareSeries™ transformed their clinics. It’s very satisfying to get that kind of feedback.”

Christina is not resting on her laurels, however. “My goal is to make sure all software by Purkinje gets usability tested. I am working with project management to integrate the user-centered design process into our software engineering lifecycle. I’m also working with Dr. Doerr on early prototyping of our next generation of EHR software.

“HFI has been an indispensable resource all along. After taking HFI’s four certification classes, I was able to share much of the material with our engineers during our Lunch and Learn sessions in St. Louis. Soon I’ll be rolling out a Usability 101 course for our developers in India, something we can video conference over the Web. They are very eager to learn.”

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