Physicians as usability evaluators - first aid for poor EHR usability?

Peer reviewe

Simulation-Based Electronic Health Record Usability Evaluation: A Proof of Concept

Poor usability of Electronic Health Records (EHR) solutions is directly associated with physician burnout. While the survey and observational methods have been utilized widely in the usability evaluation of EHRs, it does not seem to be helping with the continuous improvement of EHR design and user satisfaction. We address this gap by presenting a discrete event simulation-based model that can add objectivity to the extant EHR usability methods. Evaluating EHR usability from the perspective of operations and workflow can help vendors design and develop better systems. This short paper presents a proof-of-concept simulation model with assumed task-time distributions. Our main research question is how we can use simulation techniques to objectively evaluate EHR usability? The simulation model results in terms of resource (clinician) utilization metrics can serve as a proxy to evaluate the efficiency component of the EHR usability at the departmental leve

A six-year repeated evaluation of computerized clinical decision support system user acceptability

OBJECTIVE: Long-term acceptability among computerized clinical decision support system (CDSS) users in pediatrics is unknown. We examine user acceptance patterns over six years of our continuous computerized CDSS integration and updates. MATERIALS AND METHODS: Users of Child Health Improvement through Computer Automation (CHICA), a CDSS integrated into clinical workflows and used in several urban pediatric community clinics, completed annual surveys including 11 questions covering user acceptability. We compared responses across years within a single healthcare system and between two healthcare systems. We used logistic regression to assess the odds of a favorable response to each question by survey year, clinic role, part-time status, and frequency of CHICA use. RESULTS: Data came from 380 completed surveys between 2011 and 2016. Responses were significantly more favorable for all but one measure by 2016 (OR range 2.90-12.17, all p < 0.01). Increasing system maturity was associated with improved perceived function of CHICA (OR range 4.24-7.58, p < 0.03). User familiarity was positively associated with perceived CDSS function (OR range 3.44-8.17, p < 0.05) and usability (OR range 9.71-15.89, p < 0.01) opinions. CONCLUSION: We present a long-term, repeated follow-up of user acceptability of a CDSS. Favorable opinions of the CDSS were more likely in frequent users, physicians and advanced practitioners, and full-time workers. CHICA acceptability increased as it matured and users become more familiar with it. System quality improvement, user support, and patience are important in achieving wide-ranging, sustainable acceptance of CDSS

Usability of information systems : Experiences of outpatient physicians, outpatient nurses, and open care social welfare professionals from three large cross-sectional surveys in Finland

Background: Many European countries are integrating healthcare and social welfare services; some also include joint information systems (ISs) in this process. Despite this, large national survey studies examining and comparing the experiences of the major professional groups regarding the usability of their health (HISs) and client information systems (CISs) are lacking.Methods: We combined the responses from three national cross-sectional surveys conducted among physicians and nurses in 2017, and social welfare professionals (SWPs) in 2019 in Finland. We selected the responses of 1,826 physicians and 774 nurses working in outpatient clinics in specialized and primary care, and 669 social workers and other SWPs working in open services. The questionnaires were adjusted from a validated instru-ment. In this study, we analyzed 11 usability-related statements.Results: The healthcare professionals (HPs) were more critical of the stability and responsiveness of their ISs than the SWPs (27-48% vs 58-65% agreed). The physicians were most dissatisfied with IS support for routine tasks (24-26% agreed). Less than half of all respondents agreed with statements concerning the ease of documentation, arrangement of fields, and terminology. While the HPs were satisfied with IS support for collaboration and in-formation exchange between professionals in the same organization, all professional groups were dissatisfied with cross-organizational support and communication with patients and clients. Almost half of the HPs considered that HISs improve the quality of care, but 80% of the SWPs disagreed that CISs help improve the quality of services. Conclusions: Overall, the physicians, nurses, and SWPs were dissatisfied with the usability of their HISs and CISs. Based on our findings, ISs should be further developed to support routine tasks, inter-and cross-organizational collaboration, and information exchange. ISs for the integration of care and services should be designed to accommodate various professional groups' different work contexts and needs.Peer reviewe

Design and validation of a new Healthcare Systems Usability Scale (HSUS) for clinical decision support systems: a mixed-methods approach

Objective To develop and validate a questionnaire to assess the usability of clinical decision support systems (CDSS) and to assist in the early identification of usability issues that may impact patient safety and quality of care. Design Mixed research methods were used to develop and validate the questionnaire. The qualitative study involved scale item development, content and face validity. Pilot testing established construct validity using factor analysis and facilitated estimates for reliability and internal consistency using the Cronbach’s alpha coefficient. Setting Two hospitals within a single National Health Service Trust. Participants We recruited a panel of 7 experts in usability and questionnaire writing for health purposes to test content validity; 10 participants to assess face validity and 78 participants for the pilot testing. To be eligible for this last phase, participants needed to be health professionals with at least 3 months experience using the local hospital electronic patient record system. Results Feedback from the face and content validity phases contributed to the development and improvement of scale items. The final Healthcare Systems Usability Scale (HSUS) proved quick to complete, easy to understand and was mostly worded by potential users. Exploratory analysis revealed four factors related to patient safety, task execution, alerts or recommendations accuracy, the effects of the system on workflow and ease of system use. These separate into four subscales: patient safety and decision effectiveness (seven items), workflow integration (six items), work effectiveness (five items) and user control (four items). These factors affect the quality of care and clinician’s ability to make informed and timely decisions when using CDSS. The HSUS has a very good reliability with global Cronbach’s alpha 0.914 and between 0.702 and 0.926 for the four subscales. Conclusion The HSUS is a valid and reliable tool for usability testing of CDSS and early identification of usability issues that may cause medical adverse events

Pesquisa de satisfação dos médicos de família do Brasil com uso de prontuários eletrônicos

Orientador: Prof. Dr. Herberto José Chong NetoCoorientadora: Profa. Dra. Solena Ziemer KusmaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Saúde da Família. Defesa : Curitiba, 16/04/2021Inclui referênciasResumo: A informatização do atendimento médico tem a premissa de melhorar a efetividade da consulta clínica, trazer mais segurança para o paciente, reduzir erros humanos, reduzir a perda de informações, aprimorar a gestão do sistema de saúde tanto do ponto de vista populacional como individual e facilitar o processo de trabalho do profissional de saúde. No entanto diversas dificuldades são encontradas especialmente na usabilidade dos sistemas pelos profissionais, muitos sistemas tornam-se entraves e fatores de estresse no trabalho. Quando não há usabilidade intuitiva o prontuário dificulta a consulta, reduz a qualidade da interação médico paciente e piora a comunicação pois o médico muda o enfoque do paciente para o preenchimento da ferramenta eletrônica. No Brasil, ainda se sabe muito pouco sobre a percepção dos médicos de família com o uso de prontuários eletrônicos, sendo necessária para identificar pontos de melhoria nos sistemas disponíveis. O objetivo da presente pesquisa é identificar o nível de satisfação dos Médicos de Família com o uso de Prontuários Eletrônicos na Atenção Primária em Saúde. Trata-se de uma pesquisa observacional transversal, com aplicação de questionário para avaliação de grau de satisfação dos usuários de prontuários eletrônicos na Atenção Primária. Para análise dos dados foi utilizada a metodologia de Mineração de Dados com as ferramentas específicas. O alto nível de satisfação estava relacionado a capacidade do prontuário prevenir erros, prescrição rápida e fácil, ajudar a atender mais pacientes e facilitar a discussão de casos e realizar tarefas. Já a insatisfação estava relacionada a um suporte técnico ruim, falta de ferramentas de suporte a decisão clínica, ser um impecílio na relação médico paciente e alertas ruins. Apesar do nível de satisfação geral ser baixo (45,4%), os médicos demonstraram gostar de usar o prontuário eletrônico (48%). Este estudo de satisfação, é uma oportunidade para os envolvidos em desenvolvimento de prontuários eletrônicos e médicos refletirem sobre as demandas mais urgentes no aprimoramento desses sistemas. Estudos como este deveriam ser repetidos regularmente para avaliarmos a evolução da satisfação dos usuários com o tempo e para planejamento de ações futuras. Palavras-chave: Prontuário Eletrônico em Saúde. Atenção Primária em Saúde. Usabilidade.Abstract: The computerization of medical care has the objective of improving the effectiveness of clinical consultation, bringing more safety to the patient, reducing human errors, reducing the loss of information, improving the management of the health system both from a population and individual level and facilitating the work process of the health care professional. However, several problems are encountered especially in the usability of the systems by professionals, many systems become barriers and stress factors at work. When there is no intuitive usability, the Eletronic Health Record (EHR) makes clinical encounter difficult, reduces the quality of the doctor-patient interaction and worsens communication because the doctor changes focus from the patient to the electronic tool. In Brazil, very little is known about the perception of family physicians with the use of electronic health records however this is necessary to identify points for improvement in the available systems. The objective of this research is to identify the level of satisfaction of Family Physicians with the use of EHR in Primary Health Care. This is a cross-sectional observational survey, with the application of a questionnaire to assess the degree of satisfaction of users of electronic health records. For data analysis, the Data Mining methodology was used with its specific tools. The high level of satisfaction was related to the ability of the HER to prevent errors, quick and easy prescription, help to attend more patients and facilitate the discussion of cases and perform tasks. Dissatisfaction, on the other hand, was related to poor technical support, lack of support tools for clinical decision, being barrier in doctor patient relationship and useless alerts. Despite the general level of satisfaction being low (45.4%), doctors showed that they liked to use EHR (48%). This satisfaction study is an opportunity for those involved in the development of electronic and medical records to reflect on the most urgent demands in the improvement of these systems. Studies like this should be repeated regularly to assess the evolution of user satisfaction over time and to plan future actions. Key-words: Eletronic Health Records. Primary Care Health. Usability

Defining usability heuristics for adoption and efficiency of an electronic workflow document management system

Usability heuristics have been established for different uses and applications as general guidelines for user interfaces. These can affect the implementation of industry solutions and play a significant role regarding cost reduction and process efficiency. The area of electronic workflow document management (EWDM) solutions, also known as workflow, lacks a formal definition of usability heuristics. With the advent of new technologies such as mobile devices, defining a set of usability heuristics contributes to the adoption and efficiency of an EWDM system. Workflow usability has been evaluated for various industries. Most significantly research has been done for electronic healthcare records (EHR). In other areas such as the financial sector and educational institutions there is also some literature available but not as abundant as for EHR. This was identified as a possible research limitation. The general purpose of this research was to establish and validate an overarching set of usability heuristics for EWDM in general. This was approached by conducting a literature review and a survey on 32 workflow consultants from Hyland Software, Inc. Quantitative and qualitative data was collected focusing on the study’s main research question: “what usability heuristics should be defined to ensure the adoption and efficiency of a workflow implementation? Findings based on regression testing and expert opinions have suggested a proposed set of usability heuristics. The final list consists of: adaptability to diverse platforms, user control, system feedback, intuitive interfaces, visibility on mobile devices, error management, help, and documentation