Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating

For more information about the Information Experience Laboratory, visit http://ielab.missouri.edu/Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level. We conducted a literature review of usability principles, especially those applicable to EMRs. The key principles identified were simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context. Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost‐efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results. (42 pages

Guidelines for the user interface design of electronic medical records in optometry

With the prevalence of digitalisation in the medical industry, e-health systems have largely replaced the traditional paper-based recording methods. At the centre of these e-health systems are Electronic Health Records (EHRs) and Electronic Medical Records (EMRs), whose benefits significantly improve physician workflows. However, provision for user interface designs (UIDs) of these systems have been so poor that they have severely hindered physician usability, disrupted their workflows and risked patient safety. UID and usability guidelines have been provided, but have been very high level and general, mostly suitable for EHRs (which are used in general practices and hospitals). These guidelines have thus been ineffective in applicability for EMRs, which are typically used in niche medical environments. Within the niche field of Optometry, physicians experience disrupted workflows as a result of poor EMR UID and usability, of which EMR guidelines to improve these challenges are scarce. Hence, the need for this research arose, aiming to create UID guidelines for EMRs in Optometry, which will help improve the usability of the optometrists’ EMR. The main research question was successfully answered to produce the set of UID Guidelines for EMRs in Optometry, which includes guidelines built upon from literature and made contextually relevant, as well as some new additions, which are more patient focused. Design Science Research (DSR) was chosen as a suitable approach, and the phased Design Science Research Process Model (DSRPM) was used to guide this research. A literature review was conducted, including EHR and EMR, usability, UIDs, Optometry, related fields, and studies previously conducted to provide guidelines, frameworks and models. The review also included studying usability problems reported on the systems and the methods to overcome them. Task Analysis (TA) was used to observe and understand the optometrists’ workflows and their interactions with their EMRs during patient appointments, also identifying EMR problem areas. To address these problems, Focus Groups (FGs) were used to brainstorm solutions in the form of EMR UID features that optometrists’ required to improve their usability. From the literature review, TAs and FGs, proposed guidelines were created. The created guidelines informed the UID of an EMR prototype, which was successfully demonstrated to optometrists during Usability Testing sessions for the evaluation. Surveys were also used for the evaluation. The results proved the guidelines were successful, and were usable, effective, efficient and of good quality. A revised, final set of guidelines was then presented. Future researchers and designers may benefit from the contributions made from this research, which are both theoretical and practical

Considerations for introducing a cloud service in health informatics: user experience monitoring of information systems

This thesis will show concrete examples about how user experience monitoring will improve security of health information systems, patient safety, efficiency, and ease of use. This thesis will prove how the current EMR systems that are stand alone in nature lack the ability of advanced error monitoring capabilities. As part of this research, I will demonstrate with detailed interviews and data collection surveys how automated user monitoring systems improve data record accuracy consistently. Key terminology to Electronic Medical Records (EMR’s) and the usability of cloud computing software solutions will be defined. EMR’s are the primary software used in hospitals for charting patient information and this research focuses on the summarization of key information to the history of healthcare technologies and their functionalities. Usability testing, cloud computing, and how security and trust are affecting the adoption of cloud-based services will also be discussed in more detail. Along with the importance of market research, how to create buyer personas, and what drives their need to buy. The study was conducted in collaboration with Adusso Ltd. in Helsinki, Finland to gain better understanding about what motivates hospital IT departments to buy and the main issues with EMR systems. In collaboration with Adusso we investigated a use case example of their existing customer Apotti leveraging the user error reduction and cost saving benefits they experienced after deploying Adusso’s UX2play system. We sought answers to these topics using semi-structured interviews and analyzing our customer profiles. We found that UI layout, interoperability, and the number of clicks that nurses spend in the EMR are major issues that most EMR systems have. This implies that companies using EMR’s should implement user monitoring to pinpoint the issues they do have so that they can be fixed and the work of physicians and clinicians can be improved

Back to the future of IT adoption and evaluation in healthcare

This is a time of expansion, hope and change in the area of Health Information Technology (HIT). In this study, we provide an in-depth perspective into the adoption and diffusion of IT in healthcare based on a review of the current literature and upon expert panel assessments of adoption and diffusion issues, achievements to date, challenges facing key e-health technologies and future possibilities. These data are synthesised in the form of a research framework showing the main three areas of e-health (Electronic Medical Records, Clinical and Administrative systems and Telehealth) on three levels (individual, organisation and system). Current adoption and diffusion challenges and future possibilities are systematically presented via this research framework to inspire practice and research with both an individual and collective view of the key health systems currently confronting the healthcare sector

MS

thesisDelivery of high quality health care requires access to complete and accurate patient information. Variation in data context and content across disparate clinical systems adversely affects the integration of information needed for effective patient care and outcomes research. This study detects the extent and nature of data variation across three disparate clinical systems used along different points of the perinatal care continuum at Intermountain Health Care (IHC). Three analytical methods were used to examine data variation: data structure analysis; clinician perception of missing data elements; and patient record review of key data values. Knowledge acquisition techniques and consensus among clinical domain experts were used to select sample data elements for the data structure analysis. Findings revealed only 17% of the sample data elements had ompatible structure and meaning across the prenatal, labor and delivery (L&D), and newborn intensive care (NICU) clinical data systems. Impact on clinician efficiency from missing and contradicting information in nonintegrated perinatal systems was captured and analyzed using a Critical Incident Technique-based clinician survey. In a 1-month period, 75% of responding clinicians reported missing data and 34% reported contradicting data. The time taken to resolve problems from 1 month's missing data was estimated to be 231 hours for 23 clinicians. Data values from patient records for eight laboratory results were compared across the three perinatal systems. The best match across any two systems was 88% (blood type) and the worst was 0% (antibody screen, chlamydia). The highest incidence of contradicting data was 2.5% for blood type. Comparing agreement of the three methods, triangulation,"" gave additional insight into IHC's data variation problem. The data model study and the patient record review study showed missing data element problems beyond what clinicians perceived. In all, the consistency of data capture in the three perinatal systems at IHC is worse than expected. The data necessary to computationally execute the logic of the perinatal care process models is intermittent and unreliable. Rework of the perinatal applications based on a uniform data model and standard terminologies will provide an infrastructure to achieve IHC's vision of interdisciplinary care."

Implementing and Evaluating a Clinical Information Interface between an Electronic Medical Record and a Patient Classification System

As a result of the Affordable Care Act and the Institute of Medicine’s initiatives, hospitals are challenged to improve outcomes as efficiently as possible. How does the national initiative of RNs partnering with other healthcare professionals to improve the quality of patient care at a lower cost, cascade down to individual organizations? One answer may come by focusing on nurse staffing in acute care hospitals. Considering the impact RNs have on patient quality outcomes and the bottom line of hospitals, appropriate management of the RN workforce is one of the most important areas hospitals can focus on in order to meet the goals of ACA and the IOM. The aim of the project is to create and implement a clinical information interface between two software solutions, by different vendors, that allows electronic medical record (EMR) data to provide source data for the patient classification system (PCS). The end result will be a classification system that is fully automated. The creation and implementation of a clinical interface between software solutions from different industry partners is a very new and innovative approach for advancing the use of software. No template for this work is available. This computerized information interface (CII) will allow Nurse Managers to use timely, accurate and consistent data to make informed decisions to manage the nursing workforce in the in-patient setting

Perspectives of Primary Care Physicians on Adopting Electronic Medical Records in the Atlanta, Georgia Area

Slow adoption of electronic medical records (EMR) by primary care physicians in medical office practices has not facilitated the EMR adoption process. The problem is the slow pace of EMR adoption by primary care physicians in the Atlanta, Georgia area has become a public health concern. Research regarding the lived experiences of these physicians with EMR implementation and utilization may identify reasons for the slow adoption. The purpose of this phenomenological study was to explore the lived experiences of primary care physicians, who practice in the Atlanta area, regarding their perception, successes, barriers, and urgency of adoption of EMR in their healthcare practice. Lewin\u27s change management model of health services served as the framework for the study. Data was collected during face-to-face interviews with 19 primary care physicians at Grady\u27s Ponce de Leon Clinic and Grady\u27s East Point Clinic in Atlanta, Georgia. Participants were physicians or residents and not those in authority to make decisions about the EMR at the two clinics. NVivo 10 and automatic coding was used for data analysis to develop themes from the interviews. The findings revealed that the adoption of EMR has enabled primary care physicians to spend more time with their patients, but the barriers such as a lack of interoperability and lack of training, has fostered a feeling of disinterestedness towards EMR adoption. This study supports positive social change that EMR adoption aids in improving patient safety and outcome

The Impact of EHR Usability Issues on the Perceived Efficiency of Non-Clinical Hospital-Based EHR Users

A survey-based study of the impact of the EHR systems usability issues on the perceived efficiency of work among non-clinical users in the hospital settings was performed June 20th to July 24th 2015. There were 160 valid responses. The results were processed in SPSS (IBM statistical application) and I determined the usability dimensions with the greatest impact on efficiency, for all EHRs and for the major EHRs (Meditech, Epic and Cerner). Helpfulness was the most frequent problem for users of all EHRs. The survey is experimental and cross-sectional. The format was 20 Likert-type questions, along with screening and demographic questions. Due to the nature of data collected (ordinal) the non-parametric analysis was performed in SPSS. The goal of the study was to figure out the main usability issues among non-clinical users of the EHR systems and to generate actionable insights for designers and developers of EHR systems

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

Closed loop medication administration using mobile nursing information system

Through this long journey of PhD study including a research on ‘Closed Loop Medication Administration Using Mobile Nursing Information System’ and the thesis writing, I obtained a lot of knowledge and experience about research method and writing. I really very appreciate the help of all my supervisors