Investigation of usability problems of electronic medical record systems in the emergency department.

BACKGROUND: Despite the benefits of using electronic medical record (EMR) systems, existing studies show that many healthcare providers are uncertain regarding their usability. The usability issues of these systems decrease their efficiency, discourage clinicians, and cause dissatisfaction among patients, which may result in safety risks and harm. OBJECTIVE: The aim of this study was to collect and analyze EMR system usability problems from actual users. Practical user interface guidelines were presented based on the medical practices of these users. METHODS: Employing an online questionnaire with a seven-point Likert scale, usability issues of EMR systems were collected from 200 emergency department healthcare providers (103 physicians (medical doctors) and 97 nurses) from South Korea. RESULTS: The most common usability problem among the physicians and nurses was generating in-patient selection. This pertained to the difficulty in finding the required information on-screen because of poor visibility and a lack of distinctiveness. CONCLUSIONS: The major problems of EMR systems and their causes were identified. It is recommended that intensive visual enhancement of EMR system interfaces should be implemented to support user tasks. By providing a better understanding of the current usability problems among medical practitioners, the results of this study can be useful for developing EMR systems with increased effectiveness and efficiency.

Development of safety and usability guideline for clinical information system.

ABSTRACT: Clinical information systems (CISs) that do not consider usability and safety could lead to harmful events. Therefore, we aimed to develop a safety and usability guideline of CISs that is comprehensive for both users and developers. And the guideline was categorized to apply actual clinical workflow and work environment.The guideline components were extracted through a systematic review of the articles published between 2000 and 2015, and existing CIS safety and/or usability design guidelines. The guideline components were categorized according to clinical workflow and types of user interface (UI). The contents of the guideline were evaluated and validated by experts with 3 specialties: medical informatics, patient safety, and human engineering.Total 1276 guideline components were extracted through article and guideline review. Of these, 464 guideline components were categorized according to 5 divisions of the clinical workflow: "Data identification and selection," "Document entry," "Order entry," "Clinical decision support and alert," and "Management". While 521 guideline components were categorized according to 4 divisions of UI: UIs related to information process steps, "Perception," "Recognition," "Control," and "Feedback". We developed a guideline draft with 219 detailed guidance for clinical task and 70 for UI. Overall appropriateness and comprehensiveness were proven to achieve more than 90% in experts' survey. However, there were significant differences among the groups of specialties in the judgment of appropriateness (P < .001) and comprehensiveness (P = .038).We developed and verified a safety and usability guideline for CIS that qualifies the requirements of both clinical workflows and usability issues. The developed guideline can be a practical tool to enhance the usability and safety of CISs. Further validation is required by applying the guideline for designing the actual CIS.

Safety and Usability Guidelines of Clinical Information Systems Integrating Clinical Workflow: A Systematic Review.

OBJECTIVES: The usability of clinical information systems (CISs) is known to be an essential consideration in ensuring patient safety as well as integrating clinical flow. This study aimed to determine how usability and safety guidelines of CIS consider clinical workflow through a systematic review in terms of the target systems, methodology, and guideline components of relevant articles. METHODS: A literature search was conducted for articles published from 2000 to 2015 in PubMed, Cochrane, EMBASE, Web of Science, and CINAHL. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement method was employed. Articles containing recommendations, principles, and evaluation items for CIS usability and safety were included. The selected articles were classified according to article type, methodology, and target systems. Taking clinical workflow into consideration, the components of guidelines were extracted and classified. RESULTS: A total of 7,401 articles were identified by keyword search. From the 76 articles remaining after abstract screening, 15 were selected through full-text review. Literature review (n = 7) was the most common methodology, followed by expert opinions (n = 6). Computerized physician order entry (n = 6) was the most frequent system. Four articles considered the entire process of clinical tasks, and two articles considered the principles of the entire process of user interface affecting clinical workflow. Only two articles performed heuristic evaluations of CISs. CONCLUSIONS: The usability and safety guidelines of CISs need improvement in guideline development methodology and with consideration of clinical workflow.

Development of Safety and Usability Guideline for Hospital Information System.

Hospital Information systems (HIS) provide efficiency in clinical practice, and give users the chances of systemic feedback, recommendations based on evidences. However, HIS without consideration of usability or patient safety could make adverse events. In this study, we suggest safety/usability guideline of HIS, extracted via systemic review of related articles. We categorized the guidelines and recommendations by clinical workflow.

Effects of Information Access Cost and Accountability on Medical Residents' Information Retrieval Strategy and Performance During Prehandover Preparation: Evidence From Interview and Simulation Study.

OBJECTIVE: We aimed to examine the effects of information access cost and accountability on medical residents' information retrieval strategy and performance during prehandover preparation. BACKGROUND: Prior studies observing doctors' prehandover practices witnessed the use of memory-intensive strategies when retrieving patient information. These strategies impose potential threats to patient safety as human memory is prone to errors. Of interest in this work are the underlying determinants of information retrieval strategy and the potential impacts on medical residents' information preparation performance. METHOD: A two-step research approach was adopted, consisting of semistructured interviews with 21 medical residents and a simulation-based experiment with 32 medical residents. RESULTS: The semistructured interviews revealed that a substantial portion of medical residents (38%) relied largely on memory for preparing handover information. The simulation-based experiment showed that higher information access cost reduced information access attempts and access duration on patient documents and harmed information preparation performance. Higher accountability led to marginally longer access to patient documents. CONCLUSION: It is important to understand the underlying determinants of medical residents' information retrieval strategy and performance during prehandover preparation. We noted the criticality of easy access to patient documents in prehandover preparation. In addition, accountability marginally influenced medical residents' information retrieval strategy. APPLICATION: Findings from this research suggested that the cost of accessing information sources should be minimized in developing handover preparation tools.

One size fits all? Challenges faced by physicians during shift handovers in a hospital with high sender/recipient ratio.

INTRODUCTION: The aim of the present study was to investigate the challenges faced by physicians during shift handovers in a university hospital that has a high handover sender/recipient ratio. METHODS: A multifaceted approach was adopted, comprising recording and analysis of handover information, rating of handover quality, and shadowing of handover recipients. Data was collected at the general medical ward of a university hospital in Singapore for a period of three months. Handover information transfer (i.e. senders' and recipients' verbal communication, and recipients' handwritten notes) and handover environmental factors were analysed. The relationship between 'to-do' tasks, and information transfer, handover quality and handover duration, were examined using analysis of variance. RESULTS: Verbal handovers for 152 patients were observed; handwritten notes on 102 (67.1%) patients and handover quality ratings for the handovers of 98 (64.5%) patients were collected. Although there was good task prioritisation (information transfer: p < 0.005, handover duration: p < 0.01), incomplete information transfer and poor implementation of nonmodifiable identifiers were observed. The high sender/recipient ratio of the hospital made face-to-face and/or bedside handover difficult to implement. Although the current handover method (i.e. use of telephone communication), allowed interactive communication, it resulted in systemic information loss due to the lack of written information. The handover environment was chaotic in the high sender/recipient ratio setting, and the physicians had no designated handover time or location. CONCLUSION: Handovers in high sender/recipient ratio settings are challenging. Efforts should be made to improve the handover processes in such situations, so that patient care is not compromised.

An investigation of differing levels of experience and indices of task management in relation to scrub nurses' performance in the operating theatre: analysis of video-taped caesarean section surgeries.

BACKGROUND: Literature has identified failures in task management as direct determinants leading to accidents in the operating theatre. However, very few studies have investigated the factors underlying task management that directly influence the performance of the scrub nurses. The traditional belief that expertise is a general indicator of performance has been empirically investigated with varying results, but none has attempted to identify the task management determinants affecting performance, as influenced by the level of expertise. OBJECTIVES: (1) To examine any difference on task management behaviours between differing levels of experience during surgeries. (2) To correlate indices of task management with levels of performance evaluated by subject matter experts. DESIGN AND SETTING: 10 experienced and 10 novice scrub nurses were randomly selected from the Obstetrics and Gynaecology Department of a teaching hospital in Singapore. All nurses partook in a caesarean section surgery each, and their work processes were recorded via a scene camera donned by themselves. PARTICIPANTS: 20 scrub nurses. METHODS: Two human factors experts independently mapped the task management processes onto a task management timeline, where individual tasks were coded, tallied and compared between levels of expertise. MAIN OUTCOME MEASURES: Reactive task management (task interruptions, task prioritizations), pro-active task management (anticipation, failures in anticipation), SPLINT scores (performance). RESULTS: Novice nurses showed lower resistance to interruptions during their tasks (58% more interruptions), especially to interruptions which were not triggered by the surgeon during their surgical counts (90% more interruptions). The novice nurses also displayed poorer/less ability to anticipate the surgeons' needs, taking longer time to handover instruments (39% longer) and making more mistakes (371% more errors). Subject matter experts rated the experienced nurses significantly higher in their cognitive non-technical skills performance than the novice nurses (32% higher). CONCLUSIONS: Experienced nurses performed better than novice nurses in all aspects of task management indices and expert evaluation. This suggested better task management as effected by expertise, displaying better prioritization, planning and awareness. With these findings, it would be easy and useful to draw causal effects that can in turn guide the design of training, leading to a desirable increase in levels of efficiency and patient safety in the operating theatre.

The effects of overall robot shape on the emotions invoked in users and the perceived personalities of robot.

The affective interaction between human and robots could be influenced by various aspects of robots, which are appearance, countenance, gesture, voice, etc. Among these, the overall shape of robot could play a key role in invoking desired emotions to the users and bestowing preferred personalities to robots. In this regard, the present study experimentally investigates the effects of overall robot shape on the emotions invoked in users and the perceived personalities of robot with an objective of deriving guidelines for the affective design of service robots. In so doing, 27 different shapes of robot were selected, modeled and fabricated, which were combinations of three different shapes of head, trunk and limb (legs and arms) - rectangular-parallelepiped, cylindrical and human-like shapes. For the experiment, visual images and real prototypes of these robot shapes were presented to participants, and emotions invoked and personalities perceived from the presented robots were measured. The results showed that the overall shape of robot arouses any of three emotions named 'concerned', 'enjoyable' and 'favorable', among which 'concerned' emotion is negatively correlated with the 'big five personality factors' while 'enjoyable' and 'favorable' emotions are positively correlated. It was found that the 'big five personality factors', and 'enjoyable' and 'favorable' emotions are more strongly perceived through the real prototypes than through the visual images. It was also found that the robot shape consisting of cylindrical head, human-like trunk and cylindrical head is the best for 'conscientious' personality and 'favorable' emotion, the robot shape consisting of cylindrical head, human-like trunk and human-like limb for 'extroverted' personality, the robot shape consisting of cylindrical head, cylindrical trunk and cylindrical limb for 'anti-neurotic' personality, and the robot shape consisting of rectangular-parallelepiped head, human-like trunk and human-like limb for 'enjoyable' emotion.

Differences in attentional strategies by novice and experienced operating theatre scrub nurses.

This study investigated the effect of nursing experience on attention allocation and task performance during surgery. The prevention of cases of retained foreign bodies after surgery typically depends on scrub nurses, who are responsible for performing multiple tasks that impose heavy demands on the nurses' cognitive resources. However, the relationship between the level of experiences and attention allocation strategies has not been extensively studied. Eye movement data were collected from 10 novice and 10 experienced scrub nurses in the operating theater for caesarean section surgeries. Visual scanning data, analyzed by dividing the workstation into four main areas and the surgery into four stages, were compared to the optimum expected value estimated by SEEV (Salience, Effort, Expectancy, and Value) model. Both experienced and novice nurses showed significant correlations to the optimal percentage dwell time values, and significant differences were found in attention allocation optimality between experienced and novice nurses, with experienced nurses adhering significantly more to the optimal in the stages of high workload. Experienced nurses spent less time on the final count and encountered fewer interruptions during the count than novices indicating better performance in task management, whereas novice nurses switched attention between areas of interest more than experienced nurses. The results provide empirical evidence of a relationship between the application of optimal visual attention management strategies and performance, opening up possibilities to the development of visual attention and interruption training for better performance.