Usability

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Usability is a quality metric that has been identified as a key factor in user satisfaction among health care professionals [1].

Usability and Clinical Decision Support

Usability is an important, though often overlooked factor in the design and implementation of electronic medical records. Usability ‘represents the art and science of preparing and conveying information so that it can be used by human beings with efficiency and effectiveness.’1 It has been demonstrated that poor usability in electronic medical records (EHR) has contributed to their poor adoption levels in the healthcare market as well as contributing to the introduction of new categories of medical error in the delivery of healthcare.1 For those who have implemented EHR’s, it is common to also utilize clinical decision support (CDS), which provides clinicians with knowledge-based information at the point of care. CDS has been developed to facilitate the practice of evidence-based medicine in order to improve healthcare quality and patient safety.2

Introduction

Thus implementers of hospital information systems need pay attention to usability to ensure acceptance among end users. To ensure usability, researchers and engineers use several key research methods to model user behavior. These methods range from qualitative observational studies to survey methods. Hollan and his colleagues describe a frame work of cyclical design that encompases distributed cognition, usability testing, and design [2]. Indeed, usability assessments find their strength in the middle of the development cycle, so that developers can make refinements to the software (also known as "formative research") [3].

On the other hand, qualitative analyses can be used to better understand physician behavior after a system has been designed. Kushniruk and colleagues demonstrated changes in diagnostic reasoning as a result of program usage; clinicians structured their interviews to match the program's work-flow [4].

Qualitative video & "think aloud" research paradigms can be used to compare or validate questionnaire responses. This methodology entails recording video either in a controlled laboratory environment or in more naturalistic environments, even in a practice site. In the "think aloud" procedure, subjects attempt to vocalize their thougts as they interact with an application. Researchers found that while satisfaction can be rated highly for an information system, the think aloud transcription show that clinicians note several shortcomings during use. This example underlines the differences between online use experience and its recall, a possible weakness of survey data.

EHR usability

EHR (Electronic Health Record) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting (1). Recently there has been an increased interest in EHR to use it as a tool to improve healthcare delivery (2). It has been argued that widespread adoption will help in improving safer and cost effective healthcare delivery (2).

There have been multiple challenges identified to the widespread adoption of EHR. One of the frequently cited challenges is EHR usability (3). Although this is a very important aspect of EHR, so far there has not been as much attention given to usability as to other aspects of EHRs like interoperability, reporting etc. Improving the usability of EHRs will support care of the “whole patient” and improve the quality, safety, efficiency, and effectiveness of care delivered in the primary care setting (4).

According to AHRQ report on Electronic Health Record Usability (4), there is need to fund research in areas of documenting pattern of clinical information use, developing and evaluating “use cases” and tools to evaluate EHR usability and developing ways to measure impact of usability and design on various aspects of EHR use, including navigating, documenting, reading, thinking, deciding, clinical decision making and efficiency of care delivery. Other areas identified to fund research were assessing current vendor and health care organization practices in regard to EHR design, identifying and evaluating existing evidence-based style sheets and guidelines, evaluating innovative ways to display complex information, identifying best practices in the use of shared (patient-clinician) views and promoting fellowships in the area of usability study and research.

AHRQ report recommended establishing certification requirement for EHR usability to make sure that EHR vendors establish and document programs for testing the usability of their systems, including potential impacts on quality and safety. It also recommended developing a national EHR usability laboratory to support public-private sharing, develop tools for evaluation or products for usability and assist vendors in product development and health care organizations in implementation of usable EHRs.

Methods of Usability

References

  1. Murff HJ, Kannry J. Physician Satisfaction with Two Order Entry Systems. J. Am Med Info Ass. 2001; 8: 499-509. [4]
  2. Holllan J, Hutchins E, Kirsh D. Distributed cognition: Toward a new foundation for human-computer interaction research. ACM Trans Comp Hum Int. 2000; 7:174-96 [5]
  3. Kushniruk AW, Patel VL. Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Info. 2004; 37:56-76.
  4. Kushniruk AW, Patel VL, Cimino JJ. Usability testing in medical informatics: Cognitive approaches to evaluation of information systems and user interfaces. [6]
  5. http://www.himss.org/ASP/topics_ehr.asp
  6. INSTITUTE OF MEDICINE, Richard S. Dick, Elaine B. Steen, and Don E. Detmer, Editors. THE COMPUTER-BASED PATIENT RECORD, Revised Edition, An Essential Technology for Health Care,1997
  7. http://www.healthcareitnews.com/blog/blog-top-10-barriers-ehr-implementation
  8. http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_907505_0_0_18/09(10)-0091-2-EF.pdf