Usability Improvement of a Clinical Decision Support System (original) (raw)
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Usability Evaluation of a Clinical Decision Support System for Geriatric ED Pain Treatment
Applied Clinical Informatics, 2016
Background: Older adults are at risk for inadequate emergency department (ED) pain care. Unrelieved acute pain is associated with poor outcomes. Clinical decision support systems (CDSS) hold promise to improve patient care, but CDSS quality varies widely, particularly when usability evaluation is not employed. Objective: To conduct an iterative usability and redesign process of a novel geriatric abdominal pain care CDSS. We hypothesized this process would result in the creation of more usable and favorable pain care interventions. Methods: Thirteen emergency physicians familiar with the Electronic Health Record (EHR) in use at the study site were recruited. Over a 10-week period, 17 1-hour usability test sessions were conducted across 3 rounds of testing. Participants were given 3 patient scenarios and provided simulated clinical care using the EHR, while interacting with the CDSS interventions. Quantitative System Usability Scores (SUS), favorability scores and qualitative narrative feedback were collected for each session. Using a multi-step review process by an interdisciplinary team, positive and negative usability issues in effectiveness, efficiency, and satisfaction were considered, prioritized and incorporated in the iterative redesign process of the CDSS. Video analysis was used to determine the appropriateness of the CDS appearances during simulated clinical care. Results: Over the 3 rounds of usability evaluations and subsequent redesign processes, mean SUS progressively improved from 74.8 to 81.2 to 88.9; mean favorability scores improved from 3.23 to 4.29 (1 worst, 5 best). Video analysis revealed that, in the course of the iterative redesign processes, rates of physicians' acknowledgment of CDS interventions increased, however most rates of desired actions by physicians (such as more frequent pain score updates) decreased. Conclusion: The iterative usability redesign process was instrumental in improving the usability of the CDSS; if implemented in practice, it could improve geriatric pain care. The usability evaluation process led to improved acknowledgement and favorability. Incorporating usability testing when designing CDSS interventions for studies may be effective to enhance clinician use.
Involving users in the design and usability evaluation of a clinical decision support system
Computer Methods and Programs in Biomedicine, 2002
Aim: To design and evaluate a clinical decision support system (CDSS) to support cardiovascular risk prevention in type 2 diabetes. Methods: A preliminary requirements specification and three prototype CDSS interface designs were developed. Seven patients and seven clinicians conducted 'usability tests' on five different task scenarios with the CDSS prototypes to test its effectiveness, efficiency and 'user-friendliness'. Structured, qualitative questions explored their preferences for the different designs and overall impressions of clinical usefulness. Results: Patients and clinicians were enthusiastic about the CDSS and used it confidently after a short learning period. Some patients had difficulty interpreting clinical data, but most were keen to see the CDSS used to help them understand their diabetes, provided a clinician explained their results. Clinicians' main concern was that the CDSS would increase consultation times. Changes suggested by users were incorporated into the final interface design. Conclusion: We have successfully incorporated patients' and clinicians' views into the design of a CDSS, but it was an arduous process.
JMIR medical informatics, 2014
Computer-based clinical decision support (CDS) is an important component of the electronic health record (EHR). As an increasing amount of CDS is implemented, it will be important that this be accomplished in a fashion that assists in clinical decision making without imposing unacceptable demands and burdens upon the provider's practice. The objective of our study was to explore an approach that allows CDS to be clinician-friendly from a variety of perspectives, to build a prototype implementation that illustrates features of the approach, and to gain experience with a pilot framework for assessment. The paper first discusses the project's design philosophy and goals. It then describes a prototype implementation (Neuropath/CDS) that explores the approach in the domain of neuropathic pain and in the context of the US Veterans Administration EHR. Finally, the paper discusses a framework for assessing the approach, illustrated by a pilot assessment of Neuropath/CDS. The paper d...
Investigating Clinical Decision Support Systems Success Factors with Usability Testing
International Journal of Advanced Computer Science and Applications, 2017
Clinical Decision Support Systems (CDSS) have been used widely since 2000s to improve the healthcare quality. CDSS can be utilized to support healthcare services as a tool to diagnose, predict, as well as to provide clinical interpretation, alert, and reminder. There are many researches of CDSS implementation on literatures but not many of them present the evidence of CDSS successful implementation. In spite of the potential use of CDSS, there are some researches that reveal the failures of CDSS implementation. This paper contributes to CDSS development by investigating and exploring CDSS success factors with usability testing. The testing involves participants from different types of backgrounds (physicians, IT developers, and students). The participants are being asked to experience three different CDSS to predict cardiovascular risk factors. The result of the research shows that involving different type of users give more insight to design process. It can be concluded that user center design is very critical to produce successful CDSS.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2008
Clinical decision support systems (CDSS) have the potential to reduce adverse medical events, but improper design can introduce new forms of error. CDSS pertaining to community acquired pneumonia and neutropenic fever were studied to determine whether usability of the graphical user interface might contribute to potential adverse medical events. Automated screen capture of 4 CDSS being used by volunteer emergency physicians was analyzed using structured methods. 422 events were recorded over 56 sessions. In total, 169 negative comments, 55 positive comments, 130 neutral comments, 21 application events, 34 problems, 6 slips, and 5 mistakes were identified. Three mistakes could have had life-threatening consequences. Evaluation of CDSS will be of utmost importance in the future with increasing use of electronic health records. Usability engineering principles can identify interface problems that may lead to potential medical adverse events, and should be incorporated early in the soft...
National questionnaire study on clinical ICT systems proofs: Physicians suffer from poor usability
International Journal of Medical Informatics, 2011
Medical informatics Computer systems evaluation Questionnaires Task performance User-computer interface Electronic health record Patient care a b s t r a c t Objective: In the health informatics field, usability studies typically focus on evaluating a single information system and involve a rather small group of end-users. However, little is known about the usability of clinical information and communication technology (ICT) environment in which healthcare professionals work daily. This paper aims at contributing to usability research and user-oriented development of healthcare technologies with three objectives: inform researchers and practitioners about the current state of usability of clinical ICT systems, increase the understanding of usability aspects specific for clinical context, and encourage a more holistic approach on studying usability issues in health informatics field. Methods: A national web questionnaire study was conducted in Finland in spring 2010 with 3929 physicians actively working in patient care. For the purposes of the study, we described three dimensions of clinical ICT system usability that reflect the physicians' viewpoint on system usage: (1) compatibility between clinical ICT systems and physicians' tasks, (2) ICT support for information exchange, communication and collaboration in clinical work, and (3) interoperability and reliability. The dimensions derive from the definitions of usability and clinical context of use analysis, and reflect the ability of ICT systems to have a positive impact on patient care by supporting physicians in achieving their goals with a pleasant user experience. The research data incorporated 32 statements with a five-point Likert-scale on physicians' experiences on usability of their currently used ICT systems and a summative question about school grade given to electronic health record (EHR) systems.
Usability Improvements to Electronic Health Records - Finding Realistic Paths to Success
2015
There is a need to develop more effective strategies for improving usability within information and communication technologies, specifically, electronic health record (EHR) systems. Usability incorporates the ease of use, learnability, efficiency, effectiveness and satisfaction of a system by the end user. When an EHR incorporates principles of usability, the system does a better job of meeting the needs of the end users intuitively, resulting in fewer errors and better quality outcomes for patients. Health systems and governments have been urging the widespread adoption of EHR systems to help lower costs and increase efficiency, putting themselves and vendors under pressure to develop and implement the best solution quickly. Too often stakeholders rely on future releases and enhancements to fix issues not originally planned for in the initial release of the product. Hospital system end users and vendors need better strategies for improving usability in EHR solutions. Poor usability can result in frustrated end-users, inefficient and more costly processes, and, at worst, compromises to patient safety. Proposed strategies and areas for future development are discussed.
Analysis of metrics for the usability evaluation of electronic health record systems
2012
Abstract. Electronic health records are gradually replacing conventional paperbased health records. For a doctor, it is a working instrument, which can significantly reduce the time spent on paper work. At the same time, patients can benefit from accessing the electronic health records even though they usually do not have a medical background. Therefore, when specifying a graphical user interface (GUI) it is necessary to take into account the requirements of the different users: e.g. the functionality for the doctors and the presentation of data in an understandable manner for the patients. The study aims to review and analyze metrics used to evaluate the usability of user interfaces in health information systems. A literature review was performed to identify existing metrics. The scope of the search included the analysis of existing usability evaluation metrics that are applied both in healthcare and other domains, where standards for storage and presentation of information are app...