Development and evaluation of nursing user interface screens using multiple methods

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This is a review for Sookyung Hyun, RN, DNS, Stephen B. Johnson, PhD, Peter D. Stetson, MD, MA, and Suzanne Bakken, RN, DNS's article from the Journal of Biomedical Informatics Dec 2009 edition entitled Development and Evaluation of Nursing User Interface Screens Using Multiple Methods.[1]


The research team at Columbia University included Sookyung Hyun, RN, DNS, Stephen B. Johnson, PhD, Peter D. Stetson, MD, MA, and Suzanne Bakken, RN, DNS. Hyun et al. developed the Structured Narrative Electronic Health Record EHR model. Aimed at using narrative data to enrich EHRs, the model integrates structured data and free text data (narratives) into a single gross structure. [1] According to the article, eNote was the parent program. The model includes a clinical document database, document ontology, natural language processing (NLP), and inference engine. The research team applied theory-based Technology Acceptance Model (TAM) and Task-Technology Fit (TTF) Model and user-centered methods. Nurses’ perceptions were used extensively. [1]

Context of the Study

Formal semantic structures encompass structured data entry and narrative text in the hybrid model that is the Structured Narrative EHR model. Formal semantic structure and NLP extraction of data documented as free text was a primary goal. [1] Structured Narrative EHR model has four major functional components: Import, Authoring, Browsing and Export. [1]

Theoretical Framework

The theoretical foundation for the study is the combined model of TAM and TTF. The TAM hypothesizes that two beliefs, perceived usefulness and perceived ease of use, are relevant to system acceptance behaviors. The TTF model addresses the relationship between task, user acceptance, and utilization. The combined model for this study addresses technology beliefs and fitness of technology for task. [1]

Match between Nursing Practice and Systems Designed to Support Nursing Practice

Consistent with the tenets of TTF, nursing Informaticians have long recognized the importance of the match between nursing practice and the systems designed to support it. Toward this goal, the criteria/requirements for nursing information systems have been studied for several decades and formalized by a number of investigators. Gassert, Lundgren and Wisser, Goossen et al., Hardiker and Bakken, Ireland et al. [1]


Hyun et al. applied theory-based and user-centered methods to elicit nurses’ perceptions of functional requirements for an electronic nursing documentation system, design user interface screens reflective of the nurses’ perspectives, and assess nurses’ perceptions of the usability of the prototype user interface screens. [1]

Elicitation of Requirements and Collaborative User Interface Design

Two nurses were domain experts. Two nursing Informaticians were usability experts. We conducted two sessions. One for brainstorming and a second for design of interface screens. Three user interface screens were designed. The Informaticians were the usability expert consultants for the registered nurses. [1]

Implementation of User Interface

The prototyped user interface screens were rendered using Dreamweaver (a Web development tool). [1]

End-User Evaluation

Hyun et al., with the Institutional Review Board approval, commenced with the prototype user interface screens evaluation by a convenience sample of five nurses. All five had at least one month’s experience with Eclipys XA (EHR), according to Hyun et al. Clinical scenarios and related documentation tasks were performed in the usability laboratory. The nurses then completed study questionnaires. Descriptive statistics were used to summarize the nurses’ responses to the original Ease of Use (PEU), Usefulness (PPU), and TTF measures. Nurses’ responses to one optional open question were summarized. Total score ranges from 0 to 52. [1]


Elicitation of Requirements and User Interface Design and Implementation

Five categories of functional requirements were identified in the brainstorming session: Information Display, Data Entry, Alerts/Reminders, Carry Forward Data, and Miscellaneous. The majority of requirements related to Information Display and Data Entry. [1]

End-User Evaluation

All nurses responded either Agree or Strongly Agree for 28 of 30 items related to PEU, PPU, and TTF. PEU scores: 4 - 32 (possible 0 to 32) PPU scores from 24 to 32 (possible 0 to 36) Nurses perceived the user interface screens as potentially useful and well-matched to nursing documentation tasks associated with admission assessment, blood trans-fusion, and patient discharge. [1]


Nursing perspectives and needs were considered when designing this documentation system and UI Screens. Hyun et al. contend that studies of this sort are necessary to help system designers meet the needs of nurses. This study confirms previous research. [1]


Imperatives for EHRs: well-matched to the users’ needs and mental models, takes advantage of features such as those in the Structured Narrative EHR model, and based upon data standards. [1]

Reviewer’s Comments

Jonzy’s Comments

This article is a bit dated but confirms sound guidelines for EHR UI design. With more studies of this sort, utilizing end-user input, a core of standard usability attributes may be developed. Thus, increasing patient safety, user confidence, and cost effectiveness.


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 Hyun, S., Johnson, S. B., Stetson, P. D., & Bakken, S. (2009). Development and Evaluation of Nursing User Interface Screens Using Multiple Methods. Journal of Biomedical Informatics, 42(6), 1004–1012. doi:10.1016/j.jbi.2009.05.005