Usability Evaluation of a Computerized Physician Order Entry for Medication Ordering

Despite CPOE (Computerized Physician Order Entry) systems’ potential to enhance patient safety by reducing medication errors, recent studies have cast some doubts on their role in error reduction. CPOE systems with poorly designed interfaces have proven to cause users dissatisfaction and to introduce new kind of errors in the ordering process, suggesting a threat instead of an enhancement of patient safety. The main objective of this study is to identify usability problems related to a CPOE medication system’s design and determining their severities. Two experts completed a cognitive walkthrough (CW) of an ordering task based on a clinical scenario for ordering the consolidation phase of chemotherapy for a leukemic patient. Fifty five usability problems were found and classified into eleven categories. CW identified cosmetic to catastrophic problems leading to inefficient use of the CPOE system and potentially resulting in users’ confusion, longer ordering duration, and medication errors. The complexity of the CPOE design, its rigidness and lack of user guidance suggests the necessity to redesign the current user interface in order to match clinicians’ ordering behaviors and to fully support them in the medication ordering process

Health Figures: An Open Source JavaScript Library for Health Data Visualization

The way we look at data has a great impact on how we can understand it, particularly when the data is related to health and wellness. Due to the increased use of self-tracking devices and the ongoing shift towards preventive medicine, better understanding of our health data is an important part of improving the general welfare of the citizens. Electronic Health Records, self-tracking devices and mobile applications provide a rich variety of data but it often becomes difficult to understand. We implemented the hFigures library inspired on the hGraph visualization with additional improvements. The purpose of the library is to provide a visual representation of the evolution of health measurements in a complete and useful manner. We researched the usefulness and usability of the library by building an application for health data visualization in a health coaching program. We performed a user evaluation with Heuristic Evaluation, Controlled User Testing and Usability Questionnaires. In the Heuristics Evaluation the average response was 6.3 out of 7 points and the Cognitive Walkthrough done by usability experts indicated no design or mismatch errors. In the CSUQ usability test the system obtained an average score of 6.13 out of 7, and in the ASQ usability test the overall satisfaction score was 6.64 out of 7. We developed hFigures, an open source library for visualizing a complete, accurate and normalized graphical representation of health data. The idea is based on the concept of the hGraph but it provides additional key features, including a comparison of multiple health measurements over time. We conducted a usability evaluation of the library as a key component of an application for health and wellness monitoring. The results indicate that the data visualization library was helpful in assisting users in understanding health data and its evolution over time.Comment: BMC Medical Informatics and Decision Making 16.1 (2016

Usability flaws of medication-related alerting functions: A systematic qualitative review

AbstractIntroductionMedication-related alerting functions may include usability flaws that limit their optimal use. A first step on the way to preventing usability flaws is to understand the characteristics of these usability flaws. This systematic qualitative review aims to analyze the type of usability flaws found in medication-related alerting functions.MethodPapers were searched via PubMed, Scopus and Ergonomics Abstracts databases, along with references lists. Paper selection, data extraction and data analysis was performed by two to three Human Factors experts. Meaningful semantic units representing instances of usability flaws were the main data extracted. They were analyzed through qualitative methods: categorization following general usability heuristics and through an inductive process for the flaws specific to medication-related alerting functions.Main resultsFrom the 6380 papers initially identified, 26 met all eligibility criteria. The analysis of the papers identified a total of 168 instances of usability flaws that could be classified into 13 categories of usability flaws representing either violations of general usability principles (i.e. they could be found in any system, e.g. guidance and workload issues) or infractions specific to medication-related alerting functions. The latter refer to issues of low signal-to-noise ratio, incomplete content of alerts, transparency, presentation mode and timing, missing alert features, tasks and control distribution.Main conclusionThe list of 168 instances of usability flaws of medication-related alerting functions provides a source of knowledge for checking the usability of medication-related alerting functions during their design and evaluation process and ultimately constructs evidence-based usability design principles for these functions

How Do Clinical Information Systems Affect the Cognitive Demands of General Practitioners?: Usability Study with a Focus on Cognitive Workload

oai:ojs.hijournal.bcs.org:article/85Background Clinical information systems in the National Health Service do not need to conform to any explicit usability requirements. Poor usability can increase the mental workload experienced by clinicians and cause fatigue, increase error rates and impact the overall patient safety. Mental workload can be used as a measure of usability.Objective To assess the subjective cognitive workload experienced by general practitioners (GPs) with their systems. To raise awareness of the importance of usability in system design among users, designers, developers and policymakers.Methods We used a modified version of the NASA Task Load Index, adapted for web. We developed a set of common clinical scenarios and computer tasks on an online survey. We emailed the study link to 199 clinical commissioning groups and 1,646 GP practices in England. Results Sixty-seven responders completed the survey. The respondents had spent an average of 17 years in general practice, had experience of using a mean of 1.5 GP computer systems and had used their current system for a mean time of 6.7 years. The mental workload score was not different among systems. There were significant differences among the task scores, but these differences were not specific to particular systems. The overall score and task scores were related to the length of experience with their present system. Conclusion Four tasks imposed a higher mental workload on GPs: ‘repeat prescribing’, ‘find episode’, ‘drug management’ and ‘overview records’. Further usability studies on GP systems should focus on these tasks. Users, policymakers, designers and developers should remain aware of the importance of usability in system design.What does this study add?• Current GP systems in England do not need to conform to explicit usability requirements. Poor usability can increase the mental workload of clinicians and lead to errors.• Some clinical computer tasks incur more cognitive workload than others and should be considered carefully during the design of a system.• GPs did not report overall very high levels of subjective cognitive workload when undertaking common clinical tasks with their systems.• Further usability studies on GP systems should focus on the tasks incurring higher cognitive workload.• Users, policymakers, and designers and developers should remain aware of the importance of usability in system design.

Usability evaluation of a computerized physician order entry for medication ordering

Despite CPOE (Computerized Physician Order Entry) systems' potential to enhance patient safety by reducing medication errors, recent studies have cast some doubts on their role in error reduction. CPOE systems with poorly designed interfaces have proven to cause users dissatisfaction and to introduce new kind of errors in the ordering process, suggesting a threat instead of an enhancement of patient safety. The main objective of this study is to identify usability problems related to a CPOE medication system's design and determining their severities. Two experts completed a cognitive walkthrough (CW) of an ordering task based on a clinical scenario for ordering the consolidation phase of chemotherapy for a leukemic patient. Fifty five usability problems were found and classified into eleven categories. CW identified cosmetic to catastrophic problems leading to inefficient use of the CPOE system and potentially resulting in users' confusion, longer ordering duration, and medication errors. The complexity of the CPOE design, its rigidness and lack of user guidance suggests the necessity to redesign the current user interface in order to match clinicians' ordering behaviors and to fully support them in the medication ordering proces

Evaluación de la seguridad de un programa informático para el registro de la administración de medicamentos en el ámbito hospitalario

La seguridad del paciente ocupa un lugar cada vez más destacado entre los objetivos de calidad de los sistemas de salud. La cadena terapéutica del medicamento en los hospitales es un sistema complejo en el que intervienen muchos profesionales y consta de numerosos procesos y etapas interrelacionados, siempre con el objetivo de hacer un uso de los medicamentos seguro, efectivo, apropiado y eficiente. Aunque los errores de medicación (EM) se pueden producir en cualquier etapa del circuito de utilización de medicamentos, la administración es el proceso más crítico en cuanto a la seguridad del paciente, por dos razones principalmente. Por un lado, se interceptan muy pocos errores de administración potenciales y, por otro lado, la mayoría de estos EM llegan al paciente con mayor probabilidad de causarle daño grave e incluso la muerte. Son pocas las barreras que existen para prevenir este tipo de EM y por ello se deben buscar estrategias para lograr que el proceso de administración de medicamentos sea lo más seguro posible. Diversas organizaciones han emitido recomendaciones para mejorar la seguridad en la administración de los medicamentos, entre estas se encuentran la utilización de nuevas tecnologías como es el registro electrónico de administración de medicamentos (REAM). Aunque las nuevas tecnologías pueden reducir los EM y mejorar la seguridad del paciente, la implementación de una tecnología no está exenta de riesgo, ya que también tiene el potencial de causar nuevos tipos de EM. Por ello, para garantizar que la herramienta para el REAM mejora la seguridad del paciente, es necesario un correcto desarrollo, y una correcta implantación y utilización..