Development and implementation of a mobile device-based pediatric electronic decision support tool as part of a national practice standardization project

OBJECTIVE: Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project. MATERIALS AND METHODS: We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE). The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics. RESULTS: Overall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5]. DISCUSSION: We observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects. CONCLUSIONS: ECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools\u27 impact on medical decision making, clinical practice, and health outcomes

Decoding the Mobile EMR User Experience: Clues to Designing Effective Healthcare Software Interfaces for Different Provider Groups

Tablets are mobile devices with tremendous potential for healthcare. They provide an untethered interface to electronic medical records. At Children’s Mercy Hospital, healthcare providers were given iPads for use at work. Healthcare providers access different EMR screens. An analysis of usage by Physicians, Nurses, Mid-Levels, and Social Support Staff reveal likes and dislikes of iPad access of EMR information

Safeuristics! Do Heuristic Evaluation Violation Severity Ratings Correlate with Patient Safety Severity Ratings for a Native Electronic Health Record Mobile Application?

Objective: Usability of electronic health records (EHRs) remains challenging, and poor EHR design has patient safety implications. Heuristic evaluation detects usability issues that can be classified by severity. The National Institute of Standards and Technology provides a safety scale for EHR usability. Our objectives were to investigate the relationship between heuristic severity ratings and safety scale ratings in an effort to analyze EHR safety. Materials and methods: Heuristic evaluation was conducted on seven common mobile EHR tasks, revealing 58 heuristic violations and 28 unique usability issues. Each usability issue was independently scored for severity by trained hospitalists and a Human Factors researcher and for safety severity by two physician informaticists and two clinical safety professionals. Results: Results demonstrated a positive correlation between heuristic severity and safety severity ratings. Regression analysis demonstrated that 49% of safety risk variability by clinical safety professionals (r = 0.70; n = 28) and 42% of safety risk variability by clinical informatics specialists (r = 0.65; n = 28) was explained by usability severity scoring of problems outlined by heuristic evaluation. Higher severity ratings of the usability issues were associated with increased perceptions of patient safety risk. Discussion: This study demonstrated the use of heuristic evaluation as a technique to quickly identify usability problems in an EHR that could lead to safety issues. Detection of higher severity ratings could help prioritize failures in EHR design that more urgently require design changes. This approach is a cost-effective technique for improving usability while impacting patient safety. Conclusion: Results from this study demonstrate the efficacy of the heuristic evaluation technique to identify usability problems that impact safety of the EHR. Also, the use of interdisciplinary teams for evaluation should be considered for severity assessment

Tablet Technology: Don\u27t Start Rounds Without It

At the conclusion of this session, participants will be able to:1. Become familiar with the capabilities of the iPad as a tool to interact with the electronic medical record.2. Demonstrate using the iPad for teaching medical learners and families.3. Understand Human Factors methods for measuring use, effectiveness, usability, and end-user satisfaction of iPad integration.Everybody\u27s talking about portable tablets. But even for the computer savvy hospitalist, the possibilities for their use are a bit daunting. With the ability to integrate with the electronic medical record and more than 100,000 apps, it is a challenge to know where to start. This workshop is for novices and experienced users. Participants will learn to integrate tablet use into their daily routine. The audience will learn how to access their hospital\u27s electronic medical record (EMR), provide education to patients and families, and to access information to aid in clinical decision making. Participants will have hands-on learning and a practical bedside understanding of the use and efficiency of portable tablets as a clinical tool. Finally, attendees will learn about assessment techniques to evaluate the ease-of-use and efficiency of portable tablet integration and how to use the data collected for cost-justification, reduction of medical errors, and continued process quality improvement

The Love/Hate Relationship of Tablets in Electronic Medical Records: A Usability Study of a Native EMR Application for Mobile Devices

Mobile devices have tremendous potential in healthcare. They provide interfaces to electronic medical records (EMRs) that are untethered. Tablets are used in home doctor visits and consultations. In Australia, providers have used tablets to access digital information in rural health clinics (Ribot, 2010). In Japan, doctors use tablets during consultations (The Yomiuri Shimbun, 2010). Providers also benefit from medical apps for tablets (Ribot, 2010; Volkmann, 2010). A study of internal medicine residents perceived improved workflow using iPads for EMR access (Patel, et al. 2012). However, more inpatient setting data is needed. Our providers were given iPads for work. While no specific regimen of usage was prescribed, one use was for EMR access. This research aims to collect objective data on tablet use for EMR interaction. Goals: 1. Examine patient care workflows using powerchart touch, a native tablet application for EMR access. 2. Evaluate strengths and weaknesses associated with using powerchart touch. METHODS: -Data collected about PowerChart Touch use in-situ. -Quantitative/qualitative data obtained through usability testing. Participants performed simulated EMR tasks on tablets. Providers were recruited who have minimum 3 months using the EMR and 1 month using powerchart touch. The study participants completed Simulated EMR-related tasks: 1. Find patient information 2. Order labs 3. Find results 4. Cancel orders 5. Write a note 6. Find handoff information 7. Examine patient data 8. Review allergies 9. Navigate information sources 10. Review orders 11. Add documents 12. Find immunizations 13. Examine patient history Video recordings and video screen capture (i.e., Morae recorder software) were obtained Demographics: Gender, age, profession, time spent/day using tablet, time spent using tablet to view EMR. Qualitative/Quantitative data: Success on task performance, time on task, user satisfaction, mental workload, task difficulty, and task confidence RESULTS: Preliminary data suggests faster documentation times and less time providers are in the EMR. It is expected that there will be distinct user advantages to native touch application design.. However, flaws in the native application design may be revealed. CONCLUSION We believe that understanding how mobile technology is currently used will improve understanding of its potential impact on a health care delivery system. Understanding the unique advantages and limitations of using tablet computers to interact with EMRs may prevent unintended consequences that could adversely impact costs, patient safety, and quality of care. Moreover understanding how providers use EMRs on tablets will help development and design of future EMR user-interfaces. Improvement of EMR user interfaces may have many indirect benefits; improved provider workflow and efficiency, improved safety and quality of care for patients, and decreased health care costs

Safeuristics! Do Heuristic Evaluation Violation Severity Ratings Correlate with Patient Safety Severity Ratings for a Native Electronic Health Record Mobile Application?

Objective Usability of electronic health records (EHRs) remains challenging, and poor EHR design has patient safety implications. Heuristic evaluation detects usability issues that can be classified by severity. The National Institute of Standards and Technology provides a safety scale for EHR usability. Our objectives were to investigate the relationship between heuristic severity ratings and safety scale ratings in an effort to analyze EHR safety.Materials and Methods Heuristic evaluation was conducted on seven common mobile EHR tasks, revealing 58 heuristic violations and 28 unique usability issues. Each usability issue was independently scored for severity by trained hospitalists and a Human Factors researcher and for safety severity by two physician informaticists and two clinical safety professionals.Results Results demonstrated a positive correlation between heuristic severity and safety severity ratings. Regression analysis demonstrated that 49% of safety risk variability by clinical safety professionals (r = 0.70; n = 28) and 42% of safety risk variability by clinical informatics specialists (r = 0.65; n = 28) was explained by usability severity scoring of problems outlined by heuristic evaluation. Higher severity ratings of the usability issues were associated with increased perceptions of patient safety risk.Discussion This study demonstrated the use of heuristic evaluation as a technique to quickly identify usability problems in an EHR that could lead to safety issues. Detection of higher severity ratings could help prioritize failures in EHR design that more urgently require design changes. This approach is a cost-effective technique for improving usability while impacting patient safety.Conclusion Results from this study demonstrate the efficacy of the heuristic evaluation technique to identify usability problems that impact safety of the EHR. Also, the use of interdisciplinary teams for evaluation should be considered for severity assessment

Development and implementation of a mobile device-based pediatric electronic decision support tool as part of a national practice standardization project

OBJECTIVE: Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project. MATERIALS AND METHODS: We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE). The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics. RESULTS: Overall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5]. DISCUSSION: We observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects. CONCLUSIONS: ECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools\u27 impact on medical decision making, clinical practice, and health outcomes