Physicians as usability evaluators - first aid for poor EHR usability?

Peer reviewe

Usability in healthcare : overcoming the mismatch between information systems and clinical work

Usability of clinical information technology (IT) systems is an ongoing topic of discussion. The systems should support healthcare professionals in their daily work with patients. However, critics indicate the prevalence of negative experiences and use related problems. The overall goal of the thesis is to examine the usability of current clinical IT systems from the viewpoint of physicians and nurses for the purposes of further user-centred system development. The thesis includes three empirical studies: a digital dictation study, evaluation of nursing documentation systems, and a national usability questionnaire study with physicians. The research was carried out utilizing contextual inquiry, interaction sequence illustration analysis, and tailored usability questionnaire methods. The research resulted in the following findings and conclusions. Currently used IT systems do not support the daily work and clinical tasks of clinicians well. This is due to numerous usability problems, and lack of computer support for multi-professional and cross-organizational collaboration between clinicians. Major improvements are needed to achieve the potential benefits clinical information and communication technology systems offer. Based on empirical studies, themes for potential improvements are: development of efficient and mobile documentation solutions, redesign of system user interfaces, solutions to support communication and collaboration, customisable and context-specific clinical IT systems, and conceptual redesign of nursing documentation system. In the field of health informatics, a need exists to broaden the scope of usability work. Usability is closely associated with evaluation and testing activities instead of design activities. Hence, the scope of usability is more restricted than it is in user-centred design and usability research fields. In order to overcome the current mismatch between IT systems and clinical work, it is important to understand that usability is extremely context-sensitive by nature. The study results indicated shortcomings in user-centred healthcare IT systems design and end-users' abilities to contribute to development work. User-centred design methods provide a variety of means to analyse, design, and evaluate information and communication systems for clinical purposes. However, the characteristics of the clinical context (e.g. privacy and data security issues, and the wide range of IT systems in use) need to be taken into account when applying the methods and performing research in real-life clinical surroundings

Menettelyprosessi käytettävyys‐ ja loppukäyttäjänäkökulman integroimiseksi tietojärjestelmähankintaan: Tapaus Apotti

Sosiaali- ja terveydenhuollon tietojärjestelmähankinnoissa käytettävyys- ja loppukäyttäjänäkökulmaa ei ole juurikaan huomioitu. Näiden yhdistämistä hankintaprosessiin on ajateltu jopa mahdottomaksi. Tässä artikkelissa kuvataan menettelyprosessi näiden näkökulmien integroimiseksi tietojärjestelmähankintaan. Kuvattava menettelyprosessi on kehitetty osana Apotti-hanketta, jossa hankinnan kohteena on sosiaali- ja terveydenhuollon yhteinen tietojärjestelmä.Menettelyprosessi sisältää viisi kokonaisuutta: (1) käytettävyystavoitteiden määrittely, (2) toiminnallisten vaatimusten ja käyttäjätarinoiden tuottaminen, (3) käytettävyysarvioinnin suunnittelu tuotevertailun tarpeisiin, (4) käytettävyysarvioinnin toteutus osana tuotevertailua, sekä (5) käytettävyyteen liittyvien vaatimusten määrittely. Menettelyprosessin kehittäminen pohjautui käyttäjäkeskeisen suunnittelun tutkimuskirjallisuuteen sekä vahvaan käytettävyysasiantuntemukseen ja terveydenhuollon tietojärjestelmäosaamiseen.Apotti-hankkeesta saatujen kokemusten perusteella kuvatun menettelyprosessin toteuttaminen vaatii tiivistä yhteistyötä käytettävyysasiantuntijoiden ja tietojärjestelmien kehittämiseen suuntautuneiden substanssiasiantuntijoiden kesken, sekä motivoituneiden loppukäyttäjien osallistumista

Kohti vertaistuen sähköisiä palveluita: Kyselytutkimus erityislapsipotilaiden vanhemmille

Terveydenhuolto on murrosvaiheessa: yhä niukkenevilla resursseilla palvelujen tulisi laajentua ja suuntautua kohti terveyden edistämistä ja sairauksien ennalta ehkäisyä. Vertaistuki ja siihen liittyvät palvelut ovat yksi mahdollisuus vastata nykypäivän haasteeseen. Tätä mahdollisuutta on kuitenkin tutkittu niukasti ja erityisesti vertaistuen sähköiset palvelut ovat vasta kehitysvaiheessa.Tässä artikkelissa kuvatun tutkimuksen tavoitteena on tukea terveydenhuoltopalveluja käyttävien erityislapsiperheiden vertaistukipalvelujen kehittämistä ja nostaa esiin sähköisten palvelujen mahdollisuuksia näiden palvelujen toteuttamisessa. Artikkelissa kuvataan erityislapsipotilaiden vanhempien näkemyksiä tämän päivän vertaistukipalveluista ja tulevaisuuden toiveita. Aineiston keruu toteutettiin osana Uuden lastensairaalan käyttäjälähtöiseen suunnitteluun liittyvää opiskelijaprojektia vuoden 2014 alussa. Aineisto koostuu sähköisellä kyselylomakkeella kerätyistä vastauksista (n=73). Vastaajat tavoitettiin erityislasten yhdistyksen sähköpostilistan ja Facebookin kautta. Kerätty laadullinen aineisto analysoitiin teemoittelemalla ja tunnistamalla esiin nousevia tarpeita.Vastausten perusteella sekä aikuiset että lapset osallistuvat runsaasti vertaistukitoimintaan. Vertaistuelta odotettiin tiedollista ja emotionaalista tukea sekä kokemusten vaihtoa ja hengähdystaukoa arjesta. Lisäksi korostettiin tapaamisen ja vapaan keskustelun merkitystä. Hoitavalta taholta, kuten sairaalan henkilökunnalta, toivottiin aktiivisempaa informointia varsinkin hoidon alkuvaiheessa. Lisäksi toivottiin sisarusten ja miesten parempaa huomiointia. Vastauksista nousivat esiin maantieteelliset erot; vertaistukitoimintaa kaivattiin enemmän järjestettäväksi myös pääkaupunkiseudun ulkopuolelle. Internet ja sosiaalinen media, erityisesti Facebook, mainittiin toimivina sähköisinä kanavina, sillä niihin pääsee osallistumaan oman kiinnostuksensa mukaan eikä lapsen sairaus tai kaukainen asuinpaikka estä sitä.Vertaistuen sähköiset palvelut ovat yksi mahdollisuus tukea vertaistuen järjestämistä ja palvelujen monipuolistamista: laajentaa verkostoja maantieteellisesti ja tuoda palvelut lähemmäs tukea tarvitsevia ja helposti saataville. Näiden palvelujen määrää tulisi lisätä ja kehittää palveluja monipuolisemmiksi sekä tietyille diagnoosiryhmille kohdennetuiksi että yli diagnoosirajojen toimiviksi. Esimerkiksi uudet lastensairaalahankkeet voisivat ottaa roolia näiden palvelujen rakentamisen tukemisessa ja vertaistukikoordinaattoreina toimimisessa

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

What constitutes the patient experience of children? Findings from the photo elicitation and the video diary study

Patient experience (PX) is getting attention among researchers and healthcare service providers, but little is known about the experiences of child patients and how to explore those. This paper reports findings from a study in which two participatory research methods, photo elicitation and video diary, were applied to investigate the elements of children’s PX in the context of children’s hospital. The aim was to find out what elements constitute the PX of children aged 7–16 years. The research data were gathered in 2016–2017. Twenty-two child patients participated in the study: eight children aged between 7 and 10 in the photo elicitation part, and fourteen children aged from 10 to 16 in the video diary part. In the analysis, the data were first analyzed per research method but afterwards combined and analyzed together. Based on the analysis, four main themes of PX of children were identified: 1) hospital facilities and entertainment, 2) medical care, 3) social relationships with the hospital personnel and other people, and 4) feelings and coping with the illness. Feedback on the research methods from the participated children was mainly positive. Further work is needed to validate the findings and introduce new creative approaches to research PX of children of different ages

End-Users' Voice in EHR Selection : Development of a Usability Questionnaire for Demonstrations in Procurement (DPUQ)

This paper describes the development of a questionnaire for evaluating usability during EHR system procurement (DPUQ). Established usability questionnaires can be used to gather user feedback after using the systems. However, during procurement, experimenting with real system use is practical only with a limited number of system candidates. There is a need for less resource-demanding usability evaluation in the early stages of procurement in cases with several vendors. DPUQ has been designed for usability evaluation by end-users during special scenario-based vendor demonstrations. The questionnaire includes three sets of questions to be used during and after the vendor demonstration. DPUQ delivers specific usability scores and can be used to compare system candidates in procurement complementing other evaluation methods.Peer reviewe

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

Measuring patient experiences in a Children's hospital with a medical clowning intervention : a case-control study

BackgroundBecause the healthcare sector is shifting to a customer-oriented approach, it is important to understand experiences of children as users of healthcare services. So far, studies that measure the influence of medical clowning on patient experiences are scarce. This study aims to measure experiences of children and their parents during day-surgery in hospital setting.MethodsA case-control study was conducted in a large Finnish children's hospital. Seventy children aged 4-17years coming for a minor operative procedure including pre-operative cannula insertion prior to surgery were included. Thirty-eight children were exposed to the medical clowning intervention and 32 children (the reference group) did not receive exposure to medical clowning. A novel digital survey tool was used to measure patient experiences before and after the insertion of a venous cannula needed for anaesthesia. The children were asked about their emotions, anxiety levels, the pain from the cannula insertion and the best and worst things about the hospital. The parents were asked about their emotions, expectations and the fluency of the procedure and the hospital day.ResultsBefore the procedure, 32% or 36% of the children in the intervention group and 44% or 28% of those in the reference group expressed positive or neutral emotions, respectively. After the procedure, 76% or 63% of children in the intervention group or reference group, respectively, expressed positive emotions. The intervention group rated the medical clowns as the best aspect of the hospital day. Both groups reported that the best aspects of the hospital day were related to the nurses and food and the worst were related to waiting and pain. Most commonly the parents felt uncertainty, anxiety or calmness before the procedure and relief afterwards. Their expectations towards the procedure related to its success and the certainty of the diagnosis.ConclusionsThe results show a trend towards more positive emotions in children with exposure to medical clowning. The digital survey tool was suitable for gathering information about the experiences of children and their parents. Information on emotions and expectations of children and parents during a procedure is useful when improving the quality of healthcare services.Trial registrationCurrent Controlled Trials NCT04312217, date of registration 17.03.2020.Retrospectively registered.Peer reviewe