Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

We Need Numbers! - Heuristic Evaluation during Demonstrations (HED) for Measuring Usability in IT System Procurement

We introduce a new usability inspection method called HED (heuristic evaluation during demonstrations) for measuring and comparing usability of competing complex IT systems in public procurement. The method presented enhances traditional heuristic evaluation to include the use context, comprehensive view of the system, and reveals missing functionality by using user scenarios and demonstrations. HED also quantifies the results in a comparable way. We present findings from a real-life validation of the method in a large-scale procurement project of a healthcare and social welfare information system. We analyze and compare the performance of HED to other usability evaluation methods used in procurement. Based on the analysis HED can be used to evaluate the level of usability of an IT system during procurement correctly, comprehensively and efficiently.Peer reviewe

An Evaluation of the Usability of a Computerized Decision Support System for Nursing Homes

Background: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices. Objective: This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents. Methods: We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis. Results: Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility’s electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers. Conclusion: Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS

Are We There Yet? Human Factors Knowledge and Health Information Technology – the Challenges of Implementation and Impact

Objective: To review the developments in human factors (HF)research on the challenges of health information technology(HIT) implementation and impact given the continuing incidenceof usability problems and unintended consequences from HITdevelopment and use.Methods: A search of PubMed/Medline and Web of Science®identified HF research published in 2015 and 2016. Electronichealth records (EHRs) and patient-centred HIT emerged assignificant foci of recent HF research. The authors selected prominentpapers highlighting ongoing HF and usability challenges inthese areas. This selective rather than systematic review of recentHF research highlights these key challenges and reflects on theirimplications on the future impact of HF research on HIT.Results: Research provides evidence of continued poor design,implementation, and usability of HIT, as well as technologyinducederrors and unintended consequences. The paperhighlights support for: (i) strengthening the evidence base on thebenefits of HF approaches; (ii) improving knowledge translationin the implementation of HF approaches during HIT design,implementation, and evaluation; (iii) increasing transparency,governance, and enforcement of HF best practices at all stages ofthe HIT system development life cycle.Discussion and Conclusion: HF and usability approaches are yetto become embedded as integral components of HIT development,implementation, and impact assessment. As HIT becomesever-more pervasive including with patients as end-users, thereis a need to expand our conceptualisation of the problems to beaddressed and the suite of tactics and strategies to be used tocalibrate our pro-active involvement in its improvement

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