System Configuration Evaluation for a Province-Wide Clinical Information System Using the eSafety Checklist.

BACKGROUND: According to Digital Health Canada 2013 eSafety Guidelines, an estimated one-third of patient safety incidents following implementation of clinical information systems (CISs) are technology-related. An eSafety checklist was previously developed to improve CIS safety by providing a comprehensive listing of system-agnostic, evidence-based configuration recommendations. OBJECTIVES: We sought to use the checklist to support safe initial configuration of a provincial system-wide CIS (Alberta, Canada), referred to as Connect Care. METHODS: The checklist was applied to 13 Connect Care modules in three successive phases. First, the checklist was adapted to an abbreviated high-priority version. Second, demonstrations of each module were recorded. Finally, independent evaluation of each recording was conducted by two eSafety evaluators using the abbreviated eSafety checklist. RESULTS: All modules achieved greater than 72% compliance, with an average of 84%. Overall, 273 opportunities for improvement were identified, with four major areas or themes emerging: (1) inconsistent date and time, (2) unclear patient identification, (3) ineffective alert system, and (4) insufficient decision support. These opportunities were forwarded to the appropriate build teams for review and implementation. CONCLUSION: This work is the first to utilize the eSafety checklist in a real-world CIS, which will become one of the largest in Canada. The checklist has shown clinical applicability in identifying gaps in CIS configuration and should be considered for use in future and pre-existing CISs.

A User-Centered Approach to Evaluating Wayfinding Systems in Healthcare.

OBJECTIVE: The purpose of this methodology is to provide the designers of wayfinding systems in healthcare facilities a process for evaluating and optimizing a design prior to implementation. The use of this methodology can improve patient experience in hospitals by preventing the installation of confusing, incomplete, and/or frustrating wayfinding systems. BACKGROUND: Despite known wayfinding and information design principles, wayfinding continues to be a challenge in healthcare environments. One reason is that the design of wayfinding systems is rarely evaluated with end users prior to implementation. The methodology outlined in this article is an application of usability testing that involves end users navigating a space using prototyped signage and other elements of a wayfinding system to determine the effectiveness of the system and identify improvement opportunities. This methodology was developed for use in an emergency department that had outdated signage and required a new wayfinding system. CONCLUSION: This methodology provides a structured process for testing and improving the design of a hospital wayfinding system prior to implementation.