Background Use of electronic clinical decision support (eCDS) has been recommended to improve implementation of clinical decision rules. Many eCDS tools, however, are designed and implemented without taking into account the context in which clinical work is performed. Implementation of the pediatric traumatic brain injury (TBI) clinical decision rule at one Level I pediatric emergency department includes an electronic questionnaire triggered when ordering a head computed tomography using computerized physician order entry (CPOE). Providers use this CPOE tool in less than 20% of trauma resuscitation cases. A human factors engineering approach could identify the implementation barriers that are limiting the use of this tool. Objectives The objective was to design a pediatric TBI eCDS tool for trauma resuscitation using a human factors approach. The hypothesis was that clinical experts will rate a usability-enhanced eCDS tool better than the existing CPOE tool for user interface design and suitability for clinical use. Methods This mixed-methods study followed usability evaluation principles. Pediatric emergency physicians were surveyed to identify barriers to using the existing eCDS tool. Using standard trauma resuscitation protocols, a hierarchical task analysis of pediatric TBI evaluation was developed. Five clinical experts, all board-certified pediatric emergency medicine faculty members, then iteratively modified the hierarchical task analysis until reaching consensus. The software team developed a prototype eCDS display using the hierarchical task analysis. Three human factors engineers provided feedback on the prototype through a heuristic evaluation, and the software team refined the eCDS tool using a rapid prototyping process. The eCDS tool then underwent iterative usability evaluations by the five clinical experts using video review of 50 trauma resuscitation cases. A final eCDS tool was created based on their feedback, with content analysis of the evaluations performed to ensure all concerns were identified and addressed. Results Among 26 EPs (76% response rate), the main barriers to using the existing tool were that the information displayed is redundant and does not fit clinical workflow. After the prototype eCDS tool was developed based on the trauma resuscitation hierarchical task analysis, the human factors engineers rated it to be better than the CPOE tool for nine of 10 standard user interface design heuristics on a three-point scale. The eCDS tool was also rated better for clinical use on the same scale, in 84% of 50 expert–video pairs, and was rated equivalent in the remainder. Clinical experts also rated barriers to use of the eCDS tool as being low. Conclusions An eCDS tool for diagnostic imaging designed using human factors engineering methods has improved perceived usability among pediatric emergency physicians.
Use of medical devices in the home that had previously been used in a healthcare facility is increasing as more care is being transferred to the home environment. To accommodate these changes, instructions for use (IFU) for these devices must be clear and understandable for patients and caregivers to be able to operate them safety. IFUs that use illustrations and graphics rather than text to convey information may make user guides more accessible. This project consisted of two phases to determine the appropriate design of a visual user guide (VUG). During the first phase, a heuristic evaluation of the manufacturer's IFU for an infusion pump was conducted. In the second phase, the heuristic evaluation results were used to inform the development of a VUG. Two rounds of iterative user testing were then conducted with a sample of target end users, with each round resulting in updates to the VUG. Findings demonstrated both major deficiencies in the usability of the manufacturer's IFU, and improvements in helpfulness ratings and subjective participant feedback as the VUG was updated based on testing recommendations. The study demonstrates the value of visual guides for patients using medical devices and the use of discount usability techniques to identify major design issues.
Smartphones and tablets continue to be weaved into our everyday lives. The proliferation of these technologies has also led to rapid growth in the number of medical technologies that are available. In particular, medical software offers a large variety of benefits, with specific applications serving as communication platforms, information references, health record databases, and much more. It is clear that medical software has myriad benefits, but it also presents many challenges, such as reliability, usability, and regulatory oversight. Thus, the objective of this discussion panel is to assemble professionals in the fields of healthcare, usability, and human-system integration to address the question: How can the sciences of human factors and medicine work together to influence the design and implementation of safe, effective mobile medical software?
The role of human factors expertise has been recognized in development or deployment of new, sophisticated, high-tech systems in healthcare organizations. By contrast, the panelists will use examples to contrast their experience in brining value of human factors expertise to healthcare through "low-tech" solutions or methods. Frontline providers face problems that demand solutions with severe constraints in resources and in scope of changes acceptable to organizations. To bring value to healthcare organizations, human factors specialists are challenged to find creative solutions, which often are low-tech. The panel will also share how problems in the healthcare environment can be approached given the financial and operational pressures that are common in such industries. The discussant will challenge the panelists to devise practical strategies beyond isolated problem-solving activities. These strategies are needed to understand and tackle complex systems problems.
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