Advancing cognitive engineering methods to support user interface design for electronic health records

Background Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. Objective In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. Methods We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. Results Dentists first reviewed the patient’s demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient’s intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient’s information and additional information needs during a typical clinician-patient encounter. Conclusion This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records

Impact of EHR Usability on Provider Efficiency and Patient Safety in Non-Hospital Settings

Healthcare organizations may reap benefits transitioning to electronic health records (EHRs), such as decreased healthcare costs and better care. However, severe unintended consequences from implementation and design of these systems have emerged. Poorly implemented EHR systems may endanger the integrity of clinical or administrative data. That, in turn, can lead to errors jeopardizing patient safety or quality of care. A literature review of 40 sources identified how EHR implementation and design can impact provider centric, patient centric, and outcomes. These categories provided the basis for a comprehensive EHR impact model that was evaluated in non-hospital settings through focus groups interviews

How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study

ObjectiveThe United States faces an opioid crisis. Integrating prescription drug monitoring programs into electronic health records offers promise to improve opioid prescribing practices. This study aimed to evaluate 2 different user interface designs for prescription drug monitoring program and electronic health record integration.Materials and MethodsTwenty-four resident physicians participated in a randomized controlled experiment using 4 simulated patient cases. In the conventional condition, prescription opioid histories were presented in tabular format, and computerized clinical decision support (CDS) was provided via interruptive modal dialogs (ie, pop-ups). The alternative condition featured a graphical opioid history, a cue to visit that history, and noninterruptive CDS. Two attending pain specialists judged prescription appropriateness.ResultsParticipants in the alternative condition wrote more appropriate prescriptions. When asked after the experiment, most participants stated that they preferred the alternative design to the conventional design.ConclusionsHow patient information and CDS are presented appears to have a significant influence on opioid prescribing behavior

Advancing Critical Care in the ICU: A Human-Centered Biomedical Data Visualization Systems

The purpose of this research is to provide medical clinicians with a new technology for interpreting large and diverse datasets to expedite critical care decision-making in the ICU. We refer to this technology as the medical information visualization assistant (MIVA). MIVA delivers multivariate biometric (bedside) data via a visualization display by transforming and organizing it into temporal resolutions that can provide contextual knowledge to clinicians. The result is a spatial organization of multiple datasets that allows rapid analysis and interpretation of trends. Findings from the usability study of the MIVA static prototype and heuristic inspection of the dynamic prototype suggest that using MIVA can yield faster and more accurate results. Furthermore, comments from the majority of the experimental group and the heuristic inspectors indicate that MIVA can facilitate clinical task flow in context-dependent health care settings

Decision support systems for adoption in dental clinics: a survey

While most dental clinicians use some sort of information system, they are involved with administrative functions, despite the advisory potential of some of these systems. This paper outlines some current decision support systems (DSS) and the common barriers facing dentists in adopting them within their workflow. These barriers include lack of perceived usefulness, complicated social and economic factors, and the difficulty for users to interpret the advice given by the system. A survey of current systems found that although there are systems that suggest treatment options, there is no real-time integration with other knowledge bases. Additionally, advice on drug prescription at point-of-care is absent from such systems, which is a significant omission, in consideration of the fact that disease management and drug prescription are common in the workflow of a dentist. This paper also addresses future trends in the research and development of dental clinical DSS, with specific emphasis on big data, standards and privacy issues to fulfil the vision of a robust, user-friendly and scalable personalised DSS for dentists. The findings of this study will offer strategies in design, research and development of a DSS with sufficient perceived usefulness to attract adoption and integration by dentists within their routine clinical workflow, thus resulting in better health outcomes for patients and increased productivity for the clinic

Experts evaluation of usability for digital solutions directed at older adults: a scoping review of reviews

Background: it is important to standardize the evaluation and reporting procedures across usability studies to guide researchers, facilitate comparisons, and promote high-quality studies. A first step to standardizing is to have an overview of how experts-based usability evaluation studies are reported across the literature. Objectives: to describe and synthesize the procedures of usability evaluation by experts that are being reported to conduct inspection usability assessments of digital solutions relevant for older adults. Methods: a scoping review of reviews was performed using a five-stage methodology to identify and describe relevant literature published between 2009 and 2020 as follows: i) identification of the research question; ii) identification of relevant studies; iii) select studies for review; iv) charting of data from selected literature; and v) collation, summary, and report of results. The research was conducted on five electronic databases: PubMed, ACM Digital Library, IEEE, Scopus, and Web of Science. The articles that met the inclusion criteria were identified, and data extracted for further analysis, including evaluators, current usability inspection methods, and instruments to support usability inspection methods. Results: a total of 3958 articles were identified. After a detailed screening, 12 reviews matched the eligibility criteria. Conclusion: overall, we found a variety of unstandardized procedures and a lack of detail on some important aspects of the assessment, including a thorough description of the evaluators and of the instruments used to facilitate the inspection evaluation such as heuristics checklists. These findings suggest the need for a consensus framework on the experts’ assessment of usability that informs researchers and allows standardization of procedures.in publicatio

Dental Hygienists\u27 Cognitive Process in Periodontal Soft Tissue Charting

Introduction: Dental hygienists have not had the opportunity to be involved in the design and development of the periodontal soft tissue charts and the surrounding interface features that are used while examining dental patients in daily practice. In some cases, dentists are able to give their opinions, wants, and needs into the development of the health information systems that they use on a daily basis, but too often, the dental hygienist is forgotten about and no input is ever given to the developers from the dental hygienists. This project considers the impact of well-designed interfaces on effectiveness and workflow particularly in regard to the dental hygienists. It is focused on improving the surrounding interface of the electronic periodontal soft tissue chart in order to provide effective and efficient patient-centered cognitive support to the dental hygienist during a patient\u27s periodontal examination. Current periodontal soft tissue charts used in daily practice lack dental hygienists’ input during development. This study will fill a gap in knowledge by defining dental hygienists’ workflow and needs, and then proposing a layout and prototype for a periodontal soft tissue chart interface that will meet those needs. Methodology: Using a multi-phase methodology (ethnographic observations, focus groups, and cognitive task analysis) the wants and needs of practicing dental hygienists were defined. Based on the results of the ethnographic observations, focus groups, and cognitive task analysis sessions, a prototypical periodontal soft tissue chart interface was developed. The prototype then underwent usability testing by dental hygienists to compare its usability versus the existing commercial software, Dentrix. Results: Ten dental hygienists participated in the ethnographic observations, focus groups, and cognitive task analysis sessions. The wants and needs of dental hygienists were determined, as well as a “common” workflow among them. Using these results, the prototypical periodontal soft tissue chart interface was developed. Usability testing comparing Dentrix and the prototype revealed that the dental hygienists completed tasks on the prototype with greater success and speed than on Dentrix. Furthermore, the dental hygienists provided more positive comments toward the prototype than Dentrix. Conclusions: This study exhibits the need to properly involve the end users – dental hygienists – in the creation of a prototypical periodontal soft tissue chart interface. Health information systems need to involve the end users at all stages in the development process in order to design and develop a system that is efficient and usable for them

Context Sensitive Health Informatics: Concepts, Methods and Tools

__Abstract__ Context is a key consideration when designing and evaluating health information technology (HIT) and cannot be overstated. Unintended consequences are common post HIT implementation and even well designed technology may not achieve desired outcomes because of contextual issues. While context should be considered in the design and evaluation of health information systems (HISs) there is a shortcoming of empirical research on contextual aspects of HIT. This conference integrates the sociotechnical and Human-Centered-Design (HCD) approaches and showcases current research on context sensitive health informatics. The papers and presentations outlines theories and models for studying contextual issues and insights on how we can better design HIT to accommodate different healthcare contexts