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Paperless by 2018 - will your NHS Trust be ready?

All Trusts are tackling the paperless agenda with resources that are stretched to capacity. Monolithic EPR Systems often fail to meet business case expectations and don’t address the move to patient involvement and multi-organisation care pathways. Often the key issues have very little to do with the technology, rather the readiness of staff within the NHS to cope with their core clinical duties – i.e. patient care and the need to record and interact with complex systems.
Here at Green River Media we firmly believe that the usability of applications is the key missing component. We recognise that mobility is a key driver to improved clinical acceptability but simply web-enabling a complex desktop system doesn’t make it more usable, often the reverse. Driving the paperless agenda is therefore a balancing act of being able to represent complex information simply and clearly on a 5 inch or 7 inch device whilst enabling clinical information, observations and so on to be gathered safely and quickly and in any location. 

Research carried out by Oxford Brookes University – Journal of Interaction Science – shows usability is affected by three main factors:

  1.    The user
  2.    The task
  3.    The context of use

When designing and developing any mobile application or attempting to port a clinical application to be used ‘on-the-move’, some factors have to be considered at the design stage.

Usability can be judged by seven attributes:

1.    Effectiveness – accesses the ability of the user to complete the specified tasks in the context, i.e. the ward, clinic, patient homes etc.

2.    Efficiency – looks at the ability of the user to complete the task with speed and accuracy. It is not efficient for a doctor to spend more time using the application than they spend with their patient.

3.    Satisfaction – judges the users attitude towards the application. Whilst it is a subjective value, it is vitally important to usability. A negative view of the mobile application will result in poor compliance and data quality.

4.    Learnability – whilst not as pertinent to health applications, it is still important to judge the ease with which a user gains proficiency with the application.

5.    Memorability – the extent to which a user can return to an application after a period of inactivity and use the application efficiently. When staff work varying shift patterns it is vital that the application flows logically and reflects process and patience.

6.    Errors – often developers and suppliers blame inadequate training or simply ‘the users’ for poor compliance and data quality. It is important to analyse errors as a guide to target re-development with a view to improving the application.

7.    Cognitive Load – the degree to which a mobile application has to take into account the nature of the user’s task whilst using the application in situ. For example if a nurse is with a patient, concentrating on supplying the correct medications, the load will increase if the system demands a high level of concentration and dexterity.

Porting an application designed for a desktop to a mobile device is often viewed from the wrong starting point – i.e. simply shrinking a desktop version. The design principles of a desktop application don’t necessarily translate to a mobile app.
Trusts are increasingly looking at recording clinical information at a patient’s bedside or indeed as there is a drive for community work, in a patient’s home. The design of mobile applications needs to focus on the following principles:

  • Ensuring context is easily determined, verified and maintained. The patient header details must be kept clear and visible and the screen real estate must not be crowded.
  • Working with users in the environment they deliver care. Go out and test usability with customers. Don’t assume a radio button is better than a drop down until you have verified it in the field.
  • Keep the primary interface as clean and uncluttered as is possible. Ensure fields that are mandatory flow logically and relegate infrequently populated fields to sub menus.
  • Don’t begin coding until you have a flow map to ensure a logical and reasonable navigational structure. Create a process map and discuss it with your user groups.
  • Don’t assume high bandwidth or even that the application can remain online constantly. Design offline contingencies that are sensible, safe and secure.
  • Use a consistent design convention and ensure that menus and error messages etc. appear in the same way and from the same point or gestures. Consider the range of devices too.

If you would like to discuss how an application could be developed for your Trust, or would simply like some advice on a project already in progress, please do not hesitate to contact us here at Green River Media.

Call 0203 397 4155 or email