Reference to “system usability” typically focuses on the traditional usability issues pursued by computer scientists and human factors investigators: the user interface. We would like to proffer a different perspective on the topic.
There are different factors in clinical information system usability and they require separation. The interface design is one, but what is also usability, which is often neglected but is arguably more important, is process usability. It is something that is macro to widget/screen real-estate, and is about the process clinicians need to follow to get their work done.
In our work on process design, we think of usability as the screen widgets and screen layout (typical human-technology interaction issues), but there is also data flow, the movement of data from the screen on which it is collected to the screens where it is used. Then there is workflow or process flow, where the processes of the staff are mapped to a system design that assists the staff in doing their work with patients. This involves things such as automatic movement from one screen to another, location of buttons or links to jump from one point in workflow to another, and delivery of contextual information required for decision making.
Our experience is that when working with the same clinical speciality in different institutions, their data collected is mostly the same, but their processes can be entirely different because the dependencies of the other disciplines around them supply services to them in very different ways.
In one tumour stream example, one department takes the patient case to the multidisciplinary team board before surgery; in another department, they take it to the MDM team after surgery. As process analysts, it is our job to support the processes of the clinical team, not to dictate what it should be.
In our opinion, the greatest determinant of a successful CIS (EMR) is the extent to which it supports the processes of the clinical teams and, subsequent to that, support for rapid process improvement.