Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

Middleton, Blackford; Bloomrosen, Meryl; Dente, Mark A.; Hashmat, Bill; Koppel, Ross; Overhage, J. Marc; Payne, Thomas H.; Rosenbloom, S. Trent; Weaver, Charlotte A.; Zhang, Jiajie

doi:10.1136/amiajnl-2012-001458

Cited by 500 publications

(336 citation statements)

References 71 publications

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“…We emphasized usability in tool development 30 and ensured that it fit within clinical workflows 31,32 and complemented physician-patient/ family communication around SHS exposure and tobacco treatment. 33 In addition, the effectiveness of this intervention likely depended on the tool's seamless integration into the EHR.…”

Section: Figurementioning

confidence: 99%

Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care

et al. 2016

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We created a clinical decision support (CDS) tool and evaluated its feasibility, acceptability, usability, and clinical impact within the electronic health record to help primary care pediatricians provide smoking cessation treatment to parents/caregivers who smoke. METHODS:This prospective study of pediatric clinicians and parents was conducted at 1 urban primary care site. Clinicians received training in smoking cessation counseling, nicotine replacement therapy (NRT) prescribing, referral to an adult treatment program, and use of the CDS tool. The tool prompted clinicians to ask about secondhand smoke exposure, provide an electronic NRT prescription, and refer. Feasibility was measured by using electronic health record utilization data, and acceptability and usability were assessed with the use of clinician surveys. Parents reported clinical impact, including NRT accepted and used.RESULTS: From June to August 2015, clinicians used the tool to screen for secondhand smoke exposure at 2286 (76%) of 3023 visits. Parent smokers were identified at 308 visits, and 165 parents (55% of smokers) were interested in and offered treatment. Twenty-four (80%) of 30 eligible pediatric clinicians used the tool. Ninety-four percent of clinicians surveyed (n = 17) were satisfied with the tool, and the average system usability scale score was 83 of 100 (good to excellent range). We reached 69 of 100 parents sampled who received treatment; 44 (64%) received NRT, and 17 (25%) were currently using NRT. CONCLUSIONS:A CDS tool to help urban primary care pediatric clinicians provide smoking cessation treatment was feasible, acceptable, usable, and influenced clinical care. A larger scale investigation in varied practice settings is warranted.

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Section: Figurementioning

confidence: 99%

Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care

et al. 2016

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“…While electronic documentation systems have the potential to improve communication and medical decision-making, they can also take more time and contribute to workflow inefficiencies and thus can be barriers to adoption of HIT [3][4][5][6][7][8]. Efficiency and physician time are critical, particularly in EDs [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…The second stage of the meaningful use program recognizes the importance of electronic documentation by including it as a menu objective to fulfill program requirements [1]. In response to these policies and incentives, emergency departments (EDs) are increasingly adopting EHRs, but only 60% of US EDs have implemented electronic charting [2].While electronic documentation systems have the potential to improve communication and medical decision-making, they can also take more time and contribute to workflow inefficiencies and thus can be barriers to adoption of HIT [3][4][5][6][7][8]. Efficiency and physician time are critical, particularly in EDs [9,10].…”

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confidence: 99%

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

Neri¹,

Redden²,

Poole³

et al. 2015

Appl Clin Inform

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SummaryObjective: To understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. Methods: We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. Results: Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. Conclusion: We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study. Research Article P.M. Neri et al.: Physicians' Perceptions of Electronic Documentation and WorkflowFor personal or educational use only. No other uses without permission. All rights reserved. BackgroundElectronic clinical documentation serves multiple purposes including communication, billing, maintenance of a legal record, and serves as a tool for synthesis and medical decision making. Electronic Health Record (EHR) incentive programs in the United States designed to stimulate health information technology (HIT) adoption require hospitals and providers to show they use the EHR "meaningfully" and meet certain objectives in order to receive incentive payments. The second stage of the meaningful use program recognizes the importance of electronic documentation by including it as a menu objective to fulfill program requirements [1]. In response to these policies and incentives, emergency departments (EDs)...

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“…Creating such a system is complex, given the necessity for considerations around security and privacy, diverse computer literacy levels of patients, the need to integrate PRO data into the workflow of professionals, and required compliance with U.S. government Section 508 specifications to assure that the software was accessible to users with disabilities [9].…”

Section: Introductionmentioning

confidence: 99%

Software for Administering the National Cancer Institute�s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events: Usability Study (Preprint)

Schoen¹,

Basch²,

Hudson³

et al. 2018

Preprint

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BACKGROUND The US National Cancer Institute (NCI) developed software to gather symptomatic adverse events directly from patients participating in clinical trials. The software administers surveys to patients using items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) through Web-based or automated telephone interfaces and facilitates the management of survey administration and the resultant data by professionals (clinicians and research associates). OBJECTIVE The purpose of this study was to iteratively evaluate and improve the usability of the PRO-CTCAE software. METHODS Heuristic evaluation of the software functionality was followed by semiscripted, think-aloud protocols in two consecutive rounds of usability testing among patients with cancer, clinicians, and research associates at 3 cancer centers. We conducted testing with patients both in clinics and at home (remotely) for both Web-based and telephone interfaces. Furthermore, we refined the software between rounds and retested. RESULTS Heuristic evaluation identified deviations from the best practices across 10 standardized categories, which informed initial software improvement. Subsequently, we conducted user-based testing among 169 patients and 47 professionals. Software modifications between rounds addressed identified issues, including difficulty using radio buttons, absence of survey progress indicators, and login problems (for patients) as well as scheduling of patient surveys (for professionals). The initial System Usability Scale (SUS) score for the patient Web-based interface was 86 and 82 (P=.22) before and after modifications, respectively, whereas the task completion score was 4.47, which improved to 4.58 (P=.39) after modifications. Following modifications for professional users, the SUS scores improved from 71 to 75 (P=.47), and the mean task performance improved significantly (4.40 vs 4.02; P=.001). CONCLUSIONS Software modifications, informed by rigorous assessment, rendered a usable system, which is currently used in multiple NCI-sponsored multicenter cancer clinical trials. CLINICALTRIAL ClinicalTrials.gov NCT01031641; https://clinicaltrials.gov/ct2/show/NCT01031641 (Archived by WebCite at http://www.webcitation.org/708hTjlTl)

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Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

Cited by 500 publications

References 71 publications

Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care

Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

Software for Administering the National Cancer Institute�s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events: Usability Study (Preprint)

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