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Our Journey to Industry-Leading EMR Usability, as Validated by KLAS

by Jeremy Delinsky, Chief Technology Officer

The news is out from KLAS, and they’ve validated our approach to the ways we design and build athenaClinicals®, our cloud-based electronic health record system: “It’s the usability, stupid!” KLAS research has recognized athenaClinicals as the most usable EMR on the market—when providers are starting to use it and over time. This is the culmination of a tremendous amount of hard work, learning, soul-searching, and organizational redesign within the athenahealth R&D team. We couldn’t be prouder of this recognition, or more committed to furthering usability as one of our most important differentiators.

The perception usually associated with great user experience is that it all springs from a single mad-genius artist who personally crafts each page and detail. This thinking is attributable to a widely read—and I believe mostly misinterpreted—Randall Stross article published by the New York Times in 2011, titled "The Auteur vs. the Committee," in which Stross compares the differences in design practices at Apple and Google.

At athenahealth, you won’t find a line of people forming outside any single office, seeking approval for every detailed design decision, souls crushed or elated based upon the judgments rendered in this brief but surgical design review.

It started nearly six years ago, when Jonathan Bush, our CEO, referred to the simplification of our user experience—broadly defined to include our services and our application—as the single most important strategic imperative for the company. Up until this point, there were two skill sets brought to the table in athenahealth product development: software engineers and a peculiar brand of technical product managers we called “Process Innovators” or “PIs” for short. Absent was anyone with formal training in interaction design, user research, or even visual design.

It’s not that we didn’t have a dominant design paradigm. We did, and it focused on the relentless pursuit of process streamlining to produce a specific, measurable business result. The team did this expertly. In fact, we built a truly innovative technical platform and business model, had been recognized as a Best-in-KLAS practice management system, and had been celebrated as a one of the most successful Initial Public Offerings of the last decade.

Enter, Mary Kate Foley. Mary Kate joined athenahealth in 2008 as our first Vice President of User Experience (UX). Her assessment of the athenahealth landscape and culture was incredibly astute— she realized that operating without earned moral authority within a highly mission-driven company, and within the R&D team in particular, was not likely to be a successful approach.

The first year was essentially spent educating the software development and PI teams about what UX, as a discipline, is all about. The next year brought the first UX-driven design breakthrough in athenaClinicals: the instantiation of our unique, five-stage patient visit in the application itself. This wasn’t gorgeous visually, but it set in motion the next major point of emphasis, the deliberate design of a patient encounter with a concept of time in mind.

We began showing our providers data that focused on their documentation speed relative to others in their practice, and across similar practices on our platform. We also shared the length of time their own staff was spending on documentation. This work helped complete the story about our ultimate alignment with athenahealth network users: If our clients are slowed down, we should get paid less. It’s a standard that we hold ourselves to internally, as part of our performance evaluations and our corporate scorecard.

While all this was going on, Mary Kate started to build one of the largest and most talented UX teams in Boston. While the wins stacked up and the team gained scale, we fundamentally changed the way product development occurred at athenahealth. Interaction designers and user researchers now joined each project team alongside developers and PIs. (And we are currently hiring for UX positions at athenahealth.)

A dominant design motivation became evident in our work, a standard that said we are here to help strip away the Greek chorus of the payer, the malpractice carrier, and the complexity of technology away from the exam room… and enable providers to be present in the moment of care with their patients.

While we’re unbelievably thrilled this has been recognized by the industry, our work, in many ways, is just beginning. Our monthly release cycle on our services encourages pragmatic iteration—and there’s a ton of it needed to meet things like Meaningful Use Stage 2 and ICD-10 requirements. And to brag a bit—we’re amazing at this. Our releases run like Swiss watches these days.

But we’re now getting on to work that all started six years ago when Jonathan announced that user experience was the strategy. We launched our mobile product this year, which was really an amuse-bouche for a more radical re-imagining of the core clinician user experience that we’re hard at work delivering. The mobile medium was a fantastic use case for a radical simplification because the form factor requires it. So while athenaClinicals, as it stands today, leads the industry in EMR usability, we’re trying to up the game, big time. We’re kicking off our second Alpha user group (pardon the potential oxymoron) this month, and will be in Beta the end of 2013 with a version of athenaNet that is a step-function different than the current version. Stay tuned, folks.

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