Identification of EMR Hardware and Space Design Requirements using Human Factors Analyses

Abstract

Electronic Medical Records (EMR) are being implemented globally in the hope of improving patient care, provider coordination, documentation accuracy, and information availability. Numerous factors impact successful EMR implementation including usability, accessibility and unique characteristics of the sociotechnical system within which it will be used. This paper describes the application of human factors methods to support effective EMR implementation at one pediatric hospital. The focus is on the problem of hardware selection and placement – a topic that has not received much attention in the literature to date. The requirements gathering process for two outpatient clinics included a task and gap analysis of current clinic workflows that led to the identification of specific hardware and design recommendations supporting future EMR workflows. Lessons learned post-implementation and requirements associated with hospital wide practices were extrapolated to generate guiding principles that apply to EMR implementation in other outpatient clinics.

Optimizing EMR User Experience: A Human Factors Approach to Hardware Assessment and Design for Inpatient and Emergency Units

“…• providing a total number of devices exceeding the number of providers working at peak times • ensuring equipment is available in locations that support clinical workflow and just-in-time documentation; and • development of a secure tap-access configuration allowing providers to log in/out of the EMR on shared workstations in less than 5 seconds. This assessment also confirmed that guiding principles identified for the ambulatory care context (see Campbell, Kramer, Kelsey, & King, 2014) remained relevant within this new context. Additional task, space and workflow requirements identified through this study led to the addition of guiding principles supporting EMR hardware design in IP and ED contexts (e.g.…”

“…This work built on a previous study within the same hospital, which involved a step-wise, iterative evaluation and implementation of the same EMR software across 72 Ambulatory Clinics (Campbell, Kramer, Kelsey, & King, 2014). Guiding principles for hardware selection and placement were developed for these ambulatory clinics, but outpatient workflow requirements were not directly transferable to IP units and the ED.…”

Cost vs. Benefit: What does NVivo Video Analysis of EMR Simulations Add to Our Understanding of User Experience?

“…Preparation included: 1) a background review of the original research protocol followed by a review and coding of related literature (e.g. Beisbroek, Shultz, Kirpatrick & Kortbeek, 2012;Campbell, Kramer, Kelsey & King, 2014;Gadd & Penrod, 2001;Trudel, Cobb, Momtahan, Brintnell & Mitchell, 2018); 2) reviewing outcomes from Phase 1 of the project; and 3) the simulation scenarios and a diagram of the simulation setup. The literature that was reviewed was coded in NVivo to help organize information and identify themes of relevance to EMR user requirements acknowledged by prior studies.…”

“…The researchers working on the manual thematic analysis had helped facilitate the simulation sessions and were familiar with the study content and scripts. They began by exploring the data through the lens of guiding principles that had been established in the previous ambulatory clinics study (Campbell, Kramer, Kelsey, and King, 2014). This approach was selected specifically to uncover if the guiding principles that arose in the ambulatory care study would also be reflected in the inpatient context.…”

Human Factors in the Wild

“…HF methods were applied to gather requirements, usability testing to select equipment, and codesign methods to re-design clinic spaces that would support future EMR workflows and positive patient-provider interaction. Contextual observation, link analysis, task and gap analysis assessments of a small number of representative clinics were extrapolated to generate guiding principles for equipment selection and placement based on hospital-wide practices (Campbell, Kramer, Kelsey, & King, 2014). Validated through a simulation study with providers, and lessons learned post-implementation of the first group of clinics, these guiding principles facilitated a shorter evaluation and design cycle for subsequent clinics, which was important given the limited HF resources available to conduct evaluations.…”