Determining the impact of usability issues of primary care physicians by expertise when using an electronic health record

Background: EHRs with poor usability present steep learning curves for new resident physicians, who are already overwhelmed in learning a new specialty. This may lead to error prone use of EHR in medical practice by new resident physicians. The goal of this study is to identify usability-related and performance-related differences that arise between primary care physicians by expertise when using an EHR. Methods: We compared usability measures after three rounds of usability tests Lab-based usability tests using video analyses were conducted to analyze learnability gaps between novice and expert physicians. Physicians completed nineteen tasks, based on an artificial but typical patient visit note. We used a mixed methods approach including quantitative performance measures (percent task success, time on task, mouse activities), a survey instrument: system usability scale (SUS), qualitative narrative feedback during the debriefing session, subtask analysis, and debriefing session with physicians. Results: Geometric mean values of percent task success rates, time on task, and mouse activities were compared between the two physician groups across three rounds. Our findings show that there were mixed changes in performance measures and expert physicians were more proficient than novice physicians on some performance measures. Thirty-one common and four unique usability issues were identified between the two physician groups across three rounds. Five themes emerged during analysis: six usability issues were related to inconsistencies, nine issues concerning user interface issues, six issues in relation to structured data issues, seven ambiguous terminology issues, and six issues in regards to workarounds. Discussion and Conclusion: This study found differences in novice and expert physicians' performance, demonstrating that physicians' proficiency did increase with EHR experience. Future directions include identifying usability issues faced by physicians when using the EHR through a more granular task analysis to recognize subtle usability issues that would have otherwise been unnoticed. Also, exploring associations between performance measures and usability issues will also be studied. Training physicians to use the EHR may decrease difficulty of completing tasks in the EHR. Improving physician training may reduce the amount of workarounds created that may lead to workflow problems. These results highlight the areas of difficulty resident physicians with different experience levels are currently facing, which may potentially improve the EHR training program and increase physicians' performance when using an EHR

Preface

Collocated with the ACM/IEEE International Conference on Model-Driven Engineering Languages and Systems (MODELS), the Educators’ Symposium (EduSymp) focuses on the huge topic of software modeling education ranging from experience reports and case studies to novel pedagogical approaches. In the following, we shortly report on the 6th EduSymp held in October 2010 in Oslo

Position Paper: Software Modeling Education

Model-driven engineering (MDE) is a promising paradigm to deal with the ever increasing complexity of modern software systems. Its powerful abstraction mechanisms allow practitioners to focus on the essential development challenges, thereby hiding the irrelevant aspects of the system under development. Within the last few years, noticeable progress has been made in putting MDE into practice,particularly in those areas where the activity of programming is substituted by modeling. The recent availability of matured  concepts and stable tools has resulted in MDE becoming more applicable in software engineering projects. Nevertheless, the availability of the best technology is worthless, if it is not accepted  and used by practitioners in the field. To alleviate this problem there is a need for extensive training both in academia and industry to fully exploit the power of MDE.In this paper, we discuss the efforts being undertaken in the educational communities to promote the application of modeling and MDE technologies and discuss several challenges which still need to be addressed

A Global Health Analysis of Socio-Economic Determinants of Health, and Human Digital Development, Health Equity and mHealth

Access to the internet, often via mobile devices, provides individuals with the ability to access the resources and economic opportunities required to live the lives they choose. Using data drawn from the World Health Organization, United Nations Development Program, and World Bank, two levels of analysis are conducted to answer the research questions: “What is the relationship between social determinants of health and human digital development?” and, “What is the relationship between health equity and mHealth?”. First, multiple regression was utilized to test two hypotheses, and second, a k-means cluster analysis was carried out categorize the countries based on these variables. Our results suggest that there is correlation between social determinants of health and human digital development; except in the case of the homelessness variable. Of the health equity variables, only the GINI index correlates with the mobile health index. A four-cluster solution in the cluster analysis illustrates that the majority of countries demonstrate low mHealth, Human Digital Development, GINI and high Education Inequality and Life Expectancy inequality. These findings have implications for how human digital development and mobile health can address social determinants of health. Future research will need to delve deeper into these connections

What is the role of ICTs in addressing health outcomes and limitations from socio-economic status?

While access to information and communication technologies (ICTs) have been touted as a key determinant for human development, few studies have investigated how ICT implementations assist people with low socioeconomic status (SES) and the impacts this might have on health outcomes. This paper investigates the relation between having access to ICTs, health outcomes, and SES. The association between socioeconomic affluence and health is even recognized by policymakers, which suggests that there is an association between SES status and health. This paper addresses the gap in the literature by investigating the research questions: 1) what is the relation between access to ICTs and fair or poor health? 2) Is there a relation between access to ICTs and socio-economic status? The findings illustrate that having less access to ICTs is related to individuals more frequently reporting fair or poor health and having less access to ICTs relates to low SES communities that are in poverty, have lower education rates, have a high number of uninsured people, have people who experience more physical distress, and live in rural areas. A key contribution is that access to ICTs does have a correlation to health and that access to ICTs have a relation to low SES. This means that ICTs can help people access resources to assist with poverty, insurance, education, physical distress, and people who live in rural populations can take advantage of ICTs to help them lead the lives they choose to live

Role of Social Determinants of Health in building an mHealth application

The pandemic has shown that the health of those with the least resources affects the rest of the population. Social determinants of health effect health disparities leading to greater inequities between those with and those without the resources needed to stay healthy. In order to help people, find resources they need to stay healthy, an mHealth application was created. Data was collected through this mobile application to investigate: what are the social determinants of health resources (SDOH) that are needed to address health inequities? Using this data, an mHealth prototype was developed to help understand whether the application can be useful in addressing the health inequities in a local community. Following a design science approach, the analysis suggests that resources for some social determinants of health are more useful than others. The contribution of this paper is in uncovering the SDOH resources that are needed to address the health inequities

Refining Clinician Workflow as a Means to Improving Catheter Quality Measures

Objective This study aimed to improve the quality measure performance for indwelling urinary catheter (IUC) duration, central venous catheter (CVC) duration, and telemetry duration by redesigning clinical decision support (CDS) tools within the documentation process and order workflow. Methods The effectiveness of the redesign was evaluated using system standard quality reporting methodology to observe device duration, central-line-associated bloodstream infection (CLABSI) rate, and catheter-associated urinary tract infection (CAUTI) rate preintervention (FY2017) and postintervention (FY2018). Electronic health record (EHR) reporting tools were used to evaluate CDS alert data both preintervention and postintervention. Results Total device duration and line days per patient days were reduced for CVC (12.8% [0.305–0.266]) and IUC (4.68% [0.171–0.163]). Mean telemetry duration was reduced by 16.94% (3.72–3.09 days), and CDS alert volume decreased 18.6% from a preintervention mean of 1.18 alerts per patient per day (81,190 total alerts) to a postintervention mean of 0.96 alerts per patient per day (61,899 total alerts). Both CLABSI (2.8% [1.07–1.04]) and CAUTI (8.1% [1.61–1.48]) rates were reduced, resulting in approximately $926,000 in savings. Conclusion In this novel model, the redesigned CDS tools improved clinician response to CDS alerts, prompting providers to take action on relevant orders that automatically updated the clinical documentation to reflect their actions. The study demonstrated that effective redesign of CDS tools within the documentation process and order workflow can reduce device duration, improve patient outcomes, and decrease CDS alert volume

Exploring The Role of Peer Observation of Teaching in Facilitating Cross-Institutional Professional Conversations About Teaching and Learning

This paper explores how cross-institutional Peer Observation of Teaching (PoT) provided a structured opportunity for professional conversations by which observers and observees shared and developed their perspectives on teaching experience and skills. Such professional conversations offer opportunities for both parties to gain a perspective on practices that may have been taken for granted. Participants from three Higher Education institutions engaged in cross-disciplinary and cross-institutional PoT, followed by facilitated reflective conversations. This paper captures the factors for success that enabled continuing conversations on teaching and learning and highlights the value of supporting such conversations outside formal, uni-institutional peer observation programmes

Utilization of low nitrogen barley for production of distilling quality malt

The potential to utilize low nitrogen barley for production of distilling quality malt was studied. This presents an opportunity to reduce the environmental impact of nitrogen fertilizer applications. Malting barley (cv. Octavia) was grown without the application of inorganic nitrogen fertilizer, to produce grain with a relatively low nitrogen concentration (1.16%, dry weight basis). Following micro-malting trials, dextrinizing units (58 DU) obtained from low nitrogen malt were much higher than a typical specification of 45 DU for malt with a conventional nitrogen concentration (&lt;1.5%). A higher soluble nitrogen ratio (SNR) or index of modification (IoM) of 49 indicated greater modification of the low nitrogen barley, resulting in higher extract released into the wort. Additionally, much lower levels of β-glucan were found in low nitrogen malt wort (64 mg/L compared with over 100 mg/L in wort of conventional nitrogen malt). Low nitrogen malt also produced higher predicted spirit yields following wort fermentation and wash distillation. These findings indicate that lower nitrogen concentration barley can be processed without negatively impacting malt quality for distilling applications. The implication of these findings to help realize more environmentally sustainable production of barley for malting and use in distilling is discussed.</p

Exploring the Readability of Ingredients Lists of Food Labels with Existing Metrics

Healthy diet and dietary behaviors are key components in prevention of chronic disease and management of chronic illness. Nutritional literacy has been associated with dietary behaviors and consumer choice of healthy foods. Nutritional literacy can be measured, for example, by examining consumer food label use, but current research focuses largely on the Nutrition Facts panel of a food product. Ingredients lists are critical for communicating food composition but are relatively unstudied in existing literature. The goal of this work is to measure the readability of ingredients lists on branded food products in the United States using existing metrics. We examined ingredients lists for all 495,646 products listed in the USDA Food Data Central database using four existing readability measures for text written in natural language. Each of these indices approximates the grade level that would be expected to comprehend a text; comparatively, patient consent forms are considered acceptable at an 8th grade reading level or lower. We report a broad variability for in readability using different metrics: ingredients lists recorded at a 9th grade reading level or higher to comprehend are found at rates of 16.5% (Automated Reading Index) to 74.9% (Gunning-Fog Index). Ingredients lists recorded at a 10th grade reading level or higher to comprehend are found at rates of 84.2% (using FRE Index). These results demonstrate the need to further explore how ingredients lists can be measured for readability, both for the purposes of consumer understanding as well as for supporting future nutrition research involving text mining