In stage 2, system validation was performed by sensitivity and specificity testing, receiver operating characteristic curve, or observer variation and can be identified at title and abstract level with MeSH search. Make forms easy to complete. Loeb Figure 1 provides a flowchart illustrating the process of filtering and coding the included studies to the five evaluation stages. W Task/expectation complexity, user variances, and organizational support are factors that influence the use of the system, but are not problems of the system itself, and need to be differentiated from system-related issues. Unfortunately, because EHRs often require complex technical integration, design and usability are often an afterthought and fail to incorporate a robust user-centered design process or full scale usability testing. UXPA supports people who research, design and evaluate the user experience of products and services, © Copyright 2020 UXPA | All rights reserved | uxmagazine@uxpa.org. L Methodological issues included lack of theoretical framework/model, lack of details regarding qualitative study approaches, single evaluation focus, environmental factors not evaluated in the early stages, and guideline adherence as the primary outcome for decision support system evaluations. User satisfaction is a subjective measure that can be assessed in the laboratory setting. . Bradshaw DF System validation was done mainly through examining sensitivity and specificity or the ROC curve, and was commonly found in computer-assisted diagnosis systems, such as computer-assisted image interpretation systems, but rarely in other documentation systems. Medical prac-titioners usually encounter usability difficulties while using a health information system like other systems. In stage 3, the user is added to the interaction to see if the system can minimize human errors and help users accomplish the task. KB P Level 3 aims to incorporate environmental factors to identify work processes and system impacts in real settings. Chin ; Poissant M Patterson Titles and abstracts were first reviewed for inclusion. But, today’s focus on meaningful use of electronic health records represents an unprecedented opportunity to refine the design process in this domain and bring a fundamental understanding of the impact of usability back into the design and development of EHRs. RH . WW The SDLC indicates ‘when’ an evaluation occurs, while the four components of usability (user, tool, task, and environment) indicate ‘what’ to evaluate. Ammenwerth Newton Shackel Kushniruk and Patel8 provided a methodological review for cognitive and usability engineering methods. The SDLC indicates ‘when’ an evaluation occurs, while the four components of usability (user, tool, task, and environment) indicate ‘what’ to evaluate. TKL Kossman . We found a total of 42 studies at stage 1. Research in HCI and computer-supported cooperative work (CSCW) has also established user-centered approaches such as participatory design and contextual enquiry to understand the relationship between technology and human activities in health care.67–71 In our review, 29 qualitative studies integrated clinicians from the beginning stages of the system development process to define clinician needs, system specification or workflow as is done with participatory design approaches. et al. Among these studies, the most frequently used questionnaires were the questionnaire for user interaction satisfaction, the modified technology acceptance model questionnaire, and the IBM usability questionnaire.50–53 However, more than half of the studies used study-generated questionnaires that were not previously validated. JF J Shortliffe V JR MA J Peute However, we did not further extract methodological data because of limited information regarding usability specification and evaluation methods. I JC . The aspect of evaluation that deals with the interaction between user and data system is called evaluation of usability ( 11 ). Qualitative methods included observation, interview, and focus group. An evaluation of perceived usability based on the level of task/expectations would then be able to reveal the system usability at each level of task/expectations. For example, phenomenology, ethnography and ground theory are commonly used to understand users' experience, culture and decision-making process, respectively. Today’s EHR implementations still have problems with system integration that can make it hard to design seamless workflows with good usability. The purpose of this paper is to review and categorize health IT usability study methods and to provide practical guidance on health IT usability evaluation. The goal of this stage is to identify users' needs in order to inform system design and establish system components. Search terms and detailed strategy are available as a data supplement online only. Gardner Yu et al. Avoid disruptions – e.g., forced logins/pop-ups. The International Organization for Standardization (ISO) has developed a standard definition of usability as “the effectiveness, efficiency and satisfaction with which specified users achieve specified goals in particular environments.” In other words, the tool must be effective in achieving the physician’s goals in using it, be an efficient way to achieve those goals, and provide the physician with the satisfaction that … Wyatt Go get involved! Based on the findings, a three-level stratified view of health IT usability evaluation is proposed and methodological guidance is offered based upon the type of interaction that is of primary interest in the evaluation. RI Rousseau et al. TT . ES J Even though identifying system features, functions, and interfaces from the user perspective is essential for the design of usable system, the perspective is frequently lacking. Roberts Jalloh The third most frequently occurring type of health IT was electronic health records. Even though there is an increased awareness regarding the importance of usability evaluation, most studies in this review provided limited information about associated evaluations relevant to each SDLC stage. Detmer Our search identified a fair number of studies (n=310) evaluating system validity for computer-assisted diagnosis systems. So, if a system was studied at different stages in different publications, it was included as one system with multiple evaluations. To ensure the best utilization of health IT, it is essential to be attentive to health IT usability, keeping in mind its intended users (eg, physicians, nurses, or pharmacists), task (eg, medication management, free-text data entry, or patient record search), and environment (eg, operation room, ward, or emergency room). To better identify usability problems at different levels of interaction, we also provided a stratified view of health IT usability evaluation to assist those conducting usability evaluations to focus on the interactions without overlooking some non-interaction factors. et al. Medical practitioners usually encounter usability difficulties while using a health information system like other systems. Full-text articles were retrieved and examined to identify final eligible studies. The analysis is informed by the proposed integrated usability specification and evaluation framework that combines a usability model and the SDLC. Shiffman The SDLC provides a commonly accepted guide for system development and evaluation. R Level 1 targets system specification to understand user-task interaction for system development. L The unit of analysis was the system. Usability represents an important yet often overlooked factor impacting the adoption and meaningful use of electronic health record (EHR) systems. Health IT types were based on the classification of Gremy and Degoulet25 and three types of decision support functions described by Musen et al.26 We organized studies based on the usability specification and evaluation framework (table 2). D Errors preventions, patient safety and privacy are vital usability factors and should not be ignored while developing a health … There are different usability factors, which are expected to influence systems’ usability. CP Proceedings of the Latin American conference on Human-computer interaction. The Magazine of the User Experience Professionals Association. E The use of information and communications technologies (ICT) in healthcare has been heralded as a potential solution to issues of high cost, poor quality, and unsatisfactory patient care experience. . P However, most qualitative studies did not provide detailed information regarding the study approaches applied to answer the research questions. J Dourish In software engineering, usability is the degree to which a software can be used by specified consumers to achieve quantified objectives with effectiveness, efficiency, and satisfaction in a quantified context of use.. Po-Yin Yen, Suzanne Bakken, Review of health information technology usability study methodologies, Journal of the American Medical Informatics Association, Volume 19, Issue 3, May 2012, Pages 413–422, https://doi.org/10.1136/amiajnl-2010-000020. Friedman Each stage has potential evaluation types that indicate component (user, task, system and environment) interaction in Bennett and Shackel's usability model, such as user–task and system–user–task. MWM Thyvalikakath . A Dykstra Health information systems that communicate with each other rely on structured vocabularies, terminologies, code sets and classification systems to represent health concepts. Musen G Kragh Iversen ISO 9241 defines usability as ‘the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use’.5 In ISO 9126, usability compliance is one of five product quality categories, in addition to understandability, learnability, operability, and attractiveness.14 Consistent with authors who contend that usability depends on the interaction between user and task in a defined environment,12,15 ISO 9126 defines usability as ‘the capability of the software product to be understood, learned, used and attractive to the user, when used under specified conditions’.14 ‘Quality in use’ is defined as ‘the capability of the software product to enable specified users to achieve specified goals with effectiveness, productivity, safety, and satisfaction in specified contexts of use’.14 In this paper, we use the broader definition of usability, that is, quality in use. Table 4 summarizes the study categorization criteria. et al. The US Department of Health and Human Services estimates that use of an EHR by office-based physician practices was up to 78% in 2013 (from 18% in 2001) and 89% of critical access hospitals were using EHRs by the end of 2013. A Fitzhenry In their classic textbook, Friedman and Wyatt11 created a categorization of study designs by primary purpose and provided an overview of general evaluation methods for biomedical informatics research. Most of the definitions of usability concern the interaction of health IT with users (nurses, physicians, patients, family members) in terms of ease of learning to use ... by the System Usability Scale, and the lowest nurse satisfaction scores (Cho et al., … K et al. The number of studies by stage was: stage 1, task-based or user–task interaction, n=42; stage 2, system–task interaction, n=310; stage 3, user–task–system interaction, n=69; stage 4, user–task–system–environment interaction, n=54; and stage 5, user–task–system–environment interaction in routine use, n=199. Researchers use these theories/models to support their study rationales. Chan Usability of health information technology (health IT) systems means many things to many people. J Good usability of health information systems is critical for health information systems to be adopted and used efficiently. Fourteen studies (20%) in stage 4 and 50 studies (26%) in stage 5 were qualitative. The diagram shows three concentric rings of elements of a UCD process. Other methods measured outcomes including guideline adherence, utilization, accuracy, document quality, medication error, patient outcomes, and cost-effectiveness. However, guideline adherence is influenced by providers' estimates of the time required to resolve reminders resulting in low adherence rates when providers estimate a long resolution time.74 Other usability barriers related to computerized reminders in this review included workflow problems, such as receipt of reminders while not with a patient, thus impairing data acquisition and/or the implementation of recommended actions; and poor system interface. Haftel E M In healthcare systems design, the aphorism says: “If content is King, context is God.” In this environment, the users are diverse, they interact with the system at a variety of different levels performing a range of work tasks from simple to complex, and they are almost always making tradeoffs based on time or resource limitations. Needham JS Laboratory information system—radiology information system, a. . This approach may potentially simplify the identification of usability problems through focusing on a specific interaction. et al. However, the studies reviewed did not directly refer to a specific study approach such as participatory design. Information extracted from each article included study design, method, participants, sample size, and health IT type. JL Search for other works by this author on: Improving patient safety by identifying side effects from introducing bar coding in medication administration, Perceptions of impact of electronic health records on nurses' work, The relationship of usability to medical error: an evaluation of errors associated with usability problems in the use of a handheld application for prescribing medications. . Y Then, we expect that users can operate the system to perform a task (stage 2 and stage 3). Evaluation types are the key to usability evaluation. Full-text articles were then examined to identify final eligibility studies. The basic idea is that collectively these practices would lead to better clinical outcomes, improved population health outcomes, increased transparency and efficiency, empowered individuals, more robust research data on health systems, and would help maintain privacy and security of patient health information. The stakeholders in the healthcare UX environment are a diverse group, including both a wide range of people and an equally diverse world of devices and systems, all of whom interact with the EHR in some way. 2025 references were initially retrieved from the Medline database from 2003 to 2009 that evaluated health IT used by clinicians. ... interoperability, usability and … Titles and abstracts were first reviewed for inclusion. Wireless PDAs boost job satisfaction for utilization review nurses, Designing medical informatics research and library–resource projects to increase what is learned, Assessment of health information technology: which questions for which systems? Sittig W Studies that fit the exclusion criteria or that had insufficient methods information for data extraction were subsequently excluded resulting in the retention of 346 studies. B ML Resourcesthe legislative, regulatory, and planning frameworks required for system functionality. Kaufman JA Gilutz . . J The other started as a niche market for technology companies with experience into existing systems in medicine. Using data contained in an EHR to facilitate these public health activities can be a substantial benefit in improving the health of an overall population. Kaufman In stages 2 and 3, the evaluation examines ‘type 2: system–task’ interaction, which is focused on system validation and performance, and also ‘type 3: user–task–system’ interaction to assess simple HCI performance in the laboratory setting. However, it does not focus on the type of interactions that are evaluated. Therefore, usability evaluation questions are: ‘What is the user, task, system, and environment interaction performance in terms of output quality, speed, accuracy, and completeness?’; ‘Is the user satisfied with the way the system helps perform a task in the real setting?’; and ‘Does the system change workflow effectiveness or efficiency?’, Twelve studies used observation, log files, and/or chart review to assess interaction performance, such as accuracy, time, completeness, and general workflow. The third question aims to understand users' work quality, such as workflow and process efficiency. Thereafter, a three-component interaction and four-component interaction are evaluated. We also categorized methods used in the usability studies, their references and example studies in appendix VI (available as a data supplement online only).
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