Combining usability evaluations to highlight the chain that leads from usability flaws to usage problems and then negative outcomes.

Poor usability of health technology is thought to diminish work system performance, increase error rates and, potentially, harm patients. The present study (i) used a combination of usability evaluation methods to highlight the chain that leads from usability flaws to usage problems experienced by users and, ultimately, to negative patient outcomes, and (ii) validated this approach by studying two different discharge summary production systems. To comply with quality guidelines, the process of drafting and sending discharge summaries is increasingly being automated. However, the usability of these systems may modify their impact (or the absence thereof) in terms of production times and quality, and must therefore be evaluated. Here, we applied three successive techniques for usability evaluation (heuristic evaluation, user testing and field observation) to two discharge summary production systems (underpinned by different technologies). The systems' main usability flaws led respectively to an increase in the time need to produce a discharge summary and the risk of patient misidentification. Our results are discussed with regard to the possibility of linking the usability flaws, usage problems and the negative outcomes by successively applying three methods for evaluating usability (heuristic evaluation, user testing and in situ observations) throughout the system development life cycle.

Using Healthcare Work Process Modelling in Hospitals to Increase the Fit Between the Healthcare Workflow and the Electronic Medical Record.

As with other organizations, hospitals tend to promote unrealistic expectations related to software implementaton. Quite often the real issue is a misfit between the software and organizational factors. Our paper shows how work process modelling within the hospital can reduce this misfit according to the vision developped by the ergonomics and the management of information systems. This idea is supported by two cases in two different University Hospitals in France, in which using work process modelling lead to identification of problems and their causes, and solutions. Modelling requires time, which may be considered costly by senior hospital managers, but also should be considered as an investment in order to achieve expected goals.

Work System Characteristics Impacting the Performance and Quality of the Discharge Letter Process.

Studies on the impact of a Health Information Technology seldom consider socio-technical characteristics of the work system in which the technology is implemented. Yet those dimensions may act as hidden variables that could explain the inconsistency of impact studies' results in terms of performance, quality and satisfaction. This paper reports on the identification of those variables in the discharge letter (DL) process. Human Factors experts performed an analysis of the work system of the DL process in 17 medical units. The DL process is composed of three sub-processes running with work system differing according to the distribution of tasks, the technology implemented and the work organization. Hidden variables identified are: verification by the physician, technology's integration, number of editing cycles, physicians' preferences etc. Those variables can be collected automatically or by questionnaire. Statistical analyses will have to be performed to know which variable explain impact indicators.

Quality indicators from laboratory and radiology information systems.

Consequences of the computerization of laboratory and radiology information system (LIS and RIS) are not well documented. The aim of this study was to evaluate the impact of computerization of LIS and RIS of four hospitals on performance and quality of care. The study was divided into three phases. First, the subprocesses and information flows of LIS and RIS were described. Then, a literature review was performed in order to identify the indicators used to assess the impact of computerization. Finally, comparisons were made between 2 hospitals. Using the initial framework, each partner described its process mapping concerning LIS and RIS. The review identified a wide panel of indicators. Only 41 were useful to assess the impact of information systems. For each two by two comparison, lists of relevant indicators have been selected from the identified indicators and according to the process mapping comparison. Two by two comparisons have to be completed. Eventually, these indicators may be integrated in the quality process of hospital information systems.

Increasing the safety of healthcare information systems through improved procurement: toward a framework for selection of safe healthcare systems.

In this article, we describe a framework that we have developed for improving the effectiveness of critical decision-making in selecting information systems. In our framework, we consider system selection in terms of strength of evidence obtained from the testing of candidate systems in order to reduce risk and increase the likelihood of selection and implementation of an effective and safe system. Two case studies, one from a major North American hospital and one from a major European hospital, are presented to illustrate how methods such as usability testing can be applied to improve system selection as well as customization (through early identification of system-organization mismatches and error-prone system features). It is argued that technology-organization fit and consideration of the potential for technology-induced error should be important selection criteria in the procurement process. Here, implications are discussed for the development of improved procurement processes to lead to safer healthcare systems.

A distributed coordination platform for home care: analysis, framework and prototype.

Good cooperation between health care (HC) professionals, patient, and family is indispensable during homecare as mentioned in reports and analyses from different countries. In a French National project named coordination for the quality of care (COQUAS), we aimed to address the problem of improving such cooperation with current tools and techniques. We hypothesized that, as in some other domains, a better integration of use and users in informatics systems could improve the usefulness of the cooperative tool. The first part of this paper is devoted to the cognitive analysis of the homecare process and highlights the requirements which should be met according to this analysis. We describe some specific features of asynchronous cooperation and some communication issues in the cooperation of HC workers. We then detail the analysis of the homecare process: methodology, description of the processes, cognitive activity analyses, and of the requirements which flow from this analysis. The second part of this paper proposes a framework and then describes a modular system prototype, designed to take into account these requirements, including aspects of both cooperation and interoperability. It uses a meta-description of actions and information derived from a cognitive study to build dynamically the interface settings; it respects the current trend in distributed architecture and uses XML communication of messages, manages complex coordination with a workflow and allows mobile work. The last part of the paper presents the evaluation which has been done with the implemented prototype, with actual homecare users.

User-centred, multidimensional assessment method of Clinical Information Systems: a case-study in anaesthesiology.

This paper describes a multi-dimensional assessment method to support the choice and acquisition process for Clinical Information Systems. The method addresses three different dimensions: (1) Quality management, which evaluates the fulfillment of Users Requirements, and the Users' satisfaction with the existing functions; (2) Usability assessment, which includes a Usability inspection, and a Usability test; (3) Performance evaluation, which assesses the exhaustiveness and quality of documentation. The method is illustrated using the case study of a Clinical Information System (CIS) acquisition for anaesthesiology. It proved efficient and promising as a support for the decision process, for enhancing users' involvement in the project, and for initiating the necessary re-engineering of the Human Computer Interface.

Homecare: the need for cooperative information systems.

Assuming responsibility of patients at home (Homecare) is organized around a complex cooperation of partners: health care actors, relatives and helpers, all of whom intervene in the patient's home and who spark off the setting up of cooperative information systems. We present our work relating to such systems within the context of home care. Such activity is based on the collaboration of multiple mobile actors, obtaining information in a multimodal fashion, while taking the job profiles and professional grades of the users into account. Information is obtained from heterogeneous systems. The quality of management of the activity of the various health care actors and of the feedback on information handled at the time of the homecare process will determine how easy it may be to set up homecare as well as the quality of care. In this paper we outline the main stages of our work: grasping the context of homecare and studying co-operative activity from a fundamental point of view but also as applied to homecare. We describe the system proposed for accessing distributed information and for organizing the supervision of the 2 fundamental processes: (1) the LOGISTICAL process (to manage the organization), (2) and the CARE Process (to follow-up the medical or nursing status of the patient), and then we enhance the contribution of mobile technologies in this context.

Multidimensional evaluation of a Clinical Information System for anaesthesiology: quality management, usability, and performances.

This paper describes a multi-dimensional assessment methodology to support the choice and selection process of Clinical Information Systems. The methodology includes 4 evaluation components: Fulfilment of Users Requirements, Usability Inspection, Usability Testing and Performance Evaluation. The methodology is illustrated with the case study of a selection of a CIS for anaesthesiology. It proved to be very efficient and powerful to support the selection process, to enhance users' involvement in the project, and to initiate the necessary re-engineering of the HCI.