Discount usability engineering
Discount Usability Engineering, founded by Jakob Nielsen , is a cost-effective method of usability evaluation based on three techniques: scenarios, simplified think-aloud, and heuristic evaluation. These often require fewer resources and time than formal usability testing.
Usability refers to the effectiveness, efficiency, and satisfaction of the user experience when using a system.
- Effectiveness - the ease in which the system allows users to achieve specific goals
- Efficiency - the length of time to achieve those goals
- Satisfaction - subjective evaluations of the system by users
Usability is becoming increasingly recognized as a correlate to EHR adoption and implementation success. Yet usability assessments are used on an inconsistent and sometimes limited basis by vendors, a common perception being that evaluations are too expensive and time consuming. Discount Usability Engineering is a method tailored to these concerns, with the goal of increasing utilization of usability evaluations.
Discount Usability Engineering Techniques
1. Scenarios - A type of extreme prototyping that reduces the level of functionality and number of features for a system to a minimum. Since these scenarios are small and simple in nature, iterative changes can occur frequently allowing for quick and frequent user feedback. Scenarios can be paper mock-ups or actual simple prototype interfaces.
2. Simplified Think-Aloud - A simple method that involves bringing in a limited number of real end-users, having them use a system to carry out typical tasks of interest, all the while having them think out loud during use. The open thought process is successful in identifying many usability issues. Data analysis is carried out on notes and observations made by experimenters. This supplants videotape or more sophisticated capturing technologies, as such elements tend to drive costs up.
3. Heuristic Evaluation - A group of experts are employed to individually evaluate systems based on commonly accepted standards and "rules of thumb" known as heuristics. In Discount Usability Engineering, the number of heuristics used for analysis is reduced to a manageable level. Typically a formal usability evaluation would utilize heuristics in the hundreds to thousands, whereas Nielsen suggests 10 fundamental heuristics  to be used in Discount Usability Engineering:
- User control and freedom
- Error prevention
- Recognition over recall
- Flexibility and efficiency
- Aesthetic and minimalist design
- Error recovery
- Help and documentation
- Schumacher R, Lowry S. NIST Guide to the processes approach for improving the usability of electronic health records. Gaithersburg, MD: National Institute for Standards and Technology; 2010. NISTIR 7741. 
- Yao P, Gorman PN. Discount usability engineering applied to an interface for Web-based medical knowledge resources. Proceedings / AMIA ... Annual Symposium. AMIA Symposium. 2000:928–932. 
- Nielsen J, editor. Guerrilla HCI: Using Discount Usability Engineering to Penetrate the Intimidation Barrier; 1994a.
- Nielsen J, editor. Ten Usability Heuristics; 1994 
- McDonnell C, Werner K, Wendel L. Electronic health record usability: vendor practices and perspectives. Rockville, MD: Agency for Healthcare Research and Quality; 2009. AHRQ Publication No. 09(10)-0091-3-EF. 
- Armijo D, McDonnell C, Werner K. Electronic health record usability: evaluation and use case framework. Rockville, MD: Agency for Healthcare Research and Quality; 2009. AHRQ Publication No. 09(10)-0091-1-EF. 
Submitted by David H. Choi, M.D.