Investigating usability and "meaningful use" of electronic medical records

In this paper, I summarize research regarding known issues with Electronic Medical Record (EMR) software design and subsequent implementation. I consider the Centers for Medicare and Medicaid Services' cash incentive for EMR adoption, and the "meaningful use" criteria that mediate that incentive (Table 1). Based on this research and my own small-scale study of real time EMR use, I outline the ways that the same problems had by EMR usability researchers are also had by actual EMR users, themselves. Specifically, questions about how to account for both embodied and cognitive effects, how to discern noise from useful information, and how to make useful what is available are all concerns shared by both care providers using EMRs and those who study EMR usability. As a result, I propose that communication design researchers design usability studies that use Mol et al's [9] construct of "care" (as a practice) as the gold standard for "meaningful use." That is, meaningful use of EMR software ought to be articulated less in terms of task-oriented record-keeping practices and the time it takes to accomplish them, but in terms of Mol et al's three components of good care: embodied practices, attuned attentiveness, and adaptive tinkering.

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