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

Classification of electronic health record–related patient safety incidents : Development and validation study

Publisher Copyright: © Sari Palojoki, Kaija Saranto, Elina Reponen, Noora Skants, Anne Vakkuri, Riikka Vuokko.Background: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective: This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods: The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied. Results: The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions: This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.Peer reviewe

A safety analysis approach to clinical workflows : application and evaluation

Clinical workflows are safety critical workflows as they have the potential to cause harm or death to patients. Their safety needs to be considered as early as possible in the development process. Effective safety analysis methods are required to ensure the safety of these high-risk workflows, because errors that may happen through routine workflow could propagate within the workflow to result in harmful failures of the system’s output. This paper shows how to apply an approach for safety analysis of clinic al workflows to analyse the safety of the workflow within a radiology department and evaluates the approach in terms of usability and benefits. The outcomes of using this approach include identification of the root causes of hazardous workflow failures that may put patients’ lives at risk. We show that the approach is applicable to this area of healthcare and is able to present added value through the detailed information on possible failures, of both their causes and effects; therefore, it has the potential to improve the safety of radiology and other clinical workflows

Effectiveness of User Centered Design for Optimizing an Electronic Documentation Form

Problem. The electronic form used by lactation consultants to document assessment findings, interventions, plans and recommendations, did not meet user’s requirements. Purpose: The purpose of this project was to evaluate the effect of optimization through a User Centered Design (UCD) process on information quality, use and user satisfaction. Goals. The goals were to provide information technology (IT) support for the organization’s Baby Friendly initiative and to support collaborative, consistent messaging for breastfeeding families which could, in turn, support exclusive breast milk feeding. Exclusive breast milk feeding is a population health initiative that could positively impact the triple aim of better care, lower costs and better health. Objectives. Information quality, use and user satisfaction affect user adoption and acceptance of IT solutions. The objective of this project was to test the effectiveness of UCD on optimization by measuring the increase in information quality, use and user satisfaction after implementation of an optimized electronic lactation assessment. Plan. Stakeholders were identified and the electronic form was optimized through UCD. A pre-test/post-test quasi-experimental design was chosen to measure the effect of optimization. Instruments included a modified version of the System and Use Assessment Survey (AHRQ, n.d.), a chart audit tool and an electronic data warehouse use query. IRB approval was obtained from COMIRB and Regis University. The pre and post data collection periods were each six weeks in length, allowing for a two week chart audit period and four week survey. The intervention was implemented after the close of the pre-test period. Clinical users were educated following the organization’s usual methods for EHR changes. Five months after the intervention, the study timeline was repeated for the post-test period. After the post-test period, a use query was run to collect data for both pre-test and post-test periods. Data were collected, coded, and entered into electronic spreadsheets for storage and analysis. Outcomes and Results. Although the sample as a whole showed no statistically significant increases in any parameter of information quality, use, or user satisfaction, when survey participants were divided by role, nurses and providers, there was a statistically significant increase in the post-test nursing group for two measures of information quality and one measure of information use. A Mann Whitney U test found a significantly higher perception of completeness of the lactation assessment, U = 200, z = -2.11, p = .035, r = .29 and reported frequency of accessing the lactation assessment from the EHR, U= 233, z = -2.01, p = .044, r = 0.26. A Fishers exact test found a statistically significant increase in the presence of lactation assessments in the post-test chart audit [1, N = 39] = 11.8, p =.001, φ= .39). The outcomes may be explained by differences in how each role uses the EHR. Additional education for providers may be necessary to overcome these differences

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