Usability evaluation of three admission and medical records subsystems integrated into nationwide hospital information systems: Heuristic evaluation

Introduction: Usability is one of the quality criteria for information systems and its weakness is one of the main barriers to the adoption of these systems. The purpose of this study was to evaluate the usability of admission and medical records module of three widely used hospital information systems (HISs). Methods: In this descriptive study the usability of admission and medical records module of three HISs (HIS1, HIS2, and HIS3) was evaluated using heuristic evaluation method. For each HIS, three expert users of the same system assessed the user interface independently, completed a usability evaluation checklist, and rated severity of each identified problem. The checklist was based on Nielsen's heuristics. For each HIS, three heuristics that have the highest and lowest problem rates and greatest severity of problems were categorized into three separate groups. The results were analyzed using descriptive statistics. Results: Although HIS1 and HIS2 were used in more hospitals than HIS3, the results showed that the usability problem rates of them were significantly higher than HIS3. The heuristics of "help and documentation", "flexibility and efficiency of use", and "visibility of system status" in the three HISs were categorized into the "highest rate of problems", "lowest rate of problems", and "highest severity of problems" groups, respectively. The heuristics of "diagnose and recover from errors", "error prevention", and "help and documentation" in HIS1 and HIS2 were categorized into the "highest rate of problems" group. Conclusions: The results of this study and previous studies show that the most common usability problems with HISs are related to heuristics of "help and documentation", "error prevention", and "help users recognize, diagnose and recover from errors." Also, the large number of hospitals using one HIS does not demonstrate its high usability to others. © 2018 Mehrdad Farzandipour, Ehsan Nabovati, Gholam-Hosein Zaeimi, Reza Khajouei

Development of a context model to prioritize drug safety alerts in CPOE systems

Background: Computerized physician order entry systems (CPOE) can reduce the number of medication errors and adverse drug events (ADEs) in healthcare institutions. Unfortunately, they tend to produce a large number of partly irrelevant alerts, in turn leading to alert overload and causing alert fatigue. The objective of this work is to identify factors that can be used to prioritize and present alerts depending on the 'context' of a clinical situation. Methods: We used a combination of literature searches and expert interviews to identify and validate the possible context factors. The internal validation of the context factors was performed by calculating the inter-rater agreement of two researcher's classification of 33 relevant articles. Results: We developed a context model containing 20 factors. We grouped these context factors into three categories: characteristics of the patient or case (e. g. clinical status of the patient); characteristics of the organizational unit or user (e. g. professional experience of the user); and alert characteristics (e. g. severity of the effect). The internal validation resulted in nearly perfect agreement (Cohen's Kappa value of 0.97). Conclusion: To our knowledge, this is the first structured attempt to develop a comprehensive context model for prioritizing drug safety alerts in CPOE systems. The outcome of this work can be used to develop future tailored drug safety alerting in CPOE systems

Quality of human-computer interaction - results of a national usability survey of hospital-IT in Germany

<p>Abstract</p> <p>Background</p> <p>Due to the increasing functionality of medical information systems, it is hard to imagine day to day work in hospitals without IT support. Therefore, the design of dialogues between humans and information systems is one of the most important issues to be addressed in health care. This survey presents an analysis of the current quality level of human-computer interaction of healthcare-IT in German hospitals, focused on the users' point of view.</p> <p>Methods</p> <p>To evaluate the usability of clinical-IT according to the design principles of EN ISO 9241-10 the IsoMetrics Inventory, an assessment tool, was used. The focus of this paper has been put on suitability for task, training effort and conformity with user expectations, differentiated by information systems. Effectiveness has been evaluated with the focus on interoperability and functionality of different IT systems.</p> <p>Results</p> <p>4521 persons from 371 hospitals visited the start page of the study, while 1003 persons from 158 hospitals completed the questionnaire. The results show relevant variations between different information systems.</p> <p>Conclusions</p> <p>Specialised information systems with defined functionality received better assessments than clinical information systems in general. This could be attributed to the improved customisation of these specialised systems for specific working environments. The results can be used as reference data for evaluation and benchmarking of human computer engineering in clinical health IT context for future studies.</p

A conceptual framework for the adoption of big data analytics by e-commerce startups: a case-based approach

E-commerce start-ups have ventured into emerging economies and are growing at a significantly faster pace. Big data has acted like a catalyst in their growth story. Big data analytics (BDA) has attracted e-commerce firms to invest in the tools and gain cutting edge over their competitors. The process of adoption of these BDA tools by e-commerce start-ups has been an area of interest as successful adoption would lead to better results. The present study aims to develop an interpretive structural model (ISM) which would act as a framework for efficient implementation of BDA. The study uses hybrid multi criteria decision making processes to develop the framework and test the same using a real-life case study. Systematic review of literature and discussion with experts resulted in exploring 11 enablers of adoption of BDA tools. Primary data collection was done from industry experts to develop an ISM framework and fuzzy MICMAC analysis is used to categorize the enablers of the adoption process. The framework is then tested by using a case study. Thematic clustering is performed to develop a simple ISM framework followed by fuzzy analytical network process (ANP) to discuss the association and ranking of enablers. The results indicate that access to relevant data forms the base of the framework and would act as the strongest enabler in the adoption process while the company rates technical skillset of employees as the most important enabler. It was also found that there is a positive correlation between the ranking of enablers emerging out of ISM and ANP. The framework helps in simplifying the strategies any e-commerce company would follow to adopt BDA in future. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

Aziz Sheikh and colleagues report the findings of their systematic overview that assessed the impact of eHealth solutions on the quality and safety of health care

A multimodal cell census and atlas of the mammalian primary motor cortex

ABSTRACT We report the generation of a multimodal cell census and atlas of the mammalian primary motor cortex (MOp or M1) as the initial product of the BRAIN Initiative Cell Census Network (BICCN). This was achieved by coordinated large-scale analyses of single-cell transcriptomes, chromatin accessibility, DNA methylomes, spatially resolved single-cell transcriptomes, morphological and electrophysiological properties, and cellular resolution input-output mapping, integrated through cross-modal computational analysis. Together, our results advance the collective knowledge and understanding of brain cell type organization: First, our study reveals a unified molecular genetic landscape of cortical cell types that congruently integrates their transcriptome, open chromatin and DNA methylation maps. Second, cross-species analysis achieves a unified taxonomy of transcriptomic types and their hierarchical organization that are conserved from mouse to marmoset and human. Third, cross-modal analysis provides compelling evidence for the epigenomic, transcriptomic, and gene regulatory basis of neuronal phenotypes such as their physiological and anatomical properties, demonstrating the biological validity and genomic underpinning of neuron types and subtypes. Fourth, in situ single-cell transcriptomics provides a spatially-resolved cell type atlas of the motor cortex. Fifth, integrated transcriptomic, epigenomic and anatomical analyses reveal the correspondence between neural circuits and transcriptomic cell types. We further present an extensive genetic toolset for targeting and fate mapping glutamatergic projection neuron types toward linking their developmental trajectory to their circuit function. Together, our results establish a unified and mechanistic framework of neuronal cell type organization that integrates multi-layered molecular genetic and spatial information with multi-faceted phenotypic properties

Usability evaluation of laboratory and radiology information systems integrated into a hospital information system

This study was conducted to evaluate the usability of widely used laboratory and radiology information systems. Three usability experts independently evaluated the user interfaces of Laboratory and Radiology Information Systems using heuristic evaluation method. They applied Nielsen's heuristics to identify and classify usability problems and Nielsen's severity rating to judge their severity. Overall, 116 unique heuristic violations were identified as usability problems. In terms of severity, 67 of problems were rated as major and catastrophic. Among 10 heuristics, "consistency and standards" was violated most frequently. Moreover, mean severity of problems concerning "error prevention" and "help and documentation" heuristics was higher than of the others. Despite widespread use of specific healthcare information systems, they suffer from usability problems. Improving the usability of systems by following existing design standards and principles from the early phased of system development life cycle is recommended. Especially, it is recommended that the designers design systems that inhibit the initiation of erroneous actions and provide sufficient guidance to users. © Springer Science+Business Media 2014

Investigating the satisfaction level of physicians in regards to implementing medical Picture Archiving and Communication System (PACS)

Background: User satisfaction with PACS is considered as one of the important criteria for assessing success in using PACS. The objective of this study was to determine the level of user satisfaction with PACS and to compare its functional features with traditional film-based systems. Methods: This study was conducted in 2017. Residents at three large university hospitals in Kerman filled-out a self-administered questionnaire consisting of three parts: demographic information of participants, user satisfaction with PACS, comparing features of the two digital and traditional imaging systems. The validity of this questionnaire was approved by five medical informatics, radiology, and health information management specialists and its reliability was confirmed by Cronbach's alpha (86). Data were analyzed using descriptive statistics and the Spearman, Mann Whitney U and Kruskal-Wallis statistical tests. Results: The mean of the participants' ages was 31.4 (±4.4) years and 59 of the participants were females. The mean of physicians' satisfaction with PACS' had no significant relationship with their age (P = 0.611), experience of using PACS (P = 0.301), specialty (P = 0.093), and percent of interpretation of images with PACS (P = 0.762). It had a significant relationship with the participants' computer skills (P = 0.022). Conclusions: The mean of physicians' satisfaction with PACS was at a moderate to a high level, yet there are still problems in the successful implementation of these systems and establishing interoperability between them. PACS has not fully met all the demands of physicians and has not achieved its predetermined objectives, such as all-access from different locations. © 2020 The Author(s)

Cosmetic Surgical Repair of Contaminated Wounds Versus Traditional Loose Approximation: Does It Increase the Rate of Wound Infections?

Background:The cosmetic result of the surgical scar has long been considered by surgeons as an important factor for patient satisfaction.On the other hand,there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth. Methods: In this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis,we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.Results:There was no significant difference in the rate of wound infection between these two groups.Conclusions:This study shows that perfect closure of the wound with subcuticular closure,which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection