Sittig Usability can be described as the capacity of a system to provide a condition for its users to perform the tasks safely, effectively, and efficiently while enjoying the experience. There are a number of limitations to the review. Picture archiving and communication system, 4. The healthcare IT organization HIMSS ( is working on the challenges of EHR usability. Health information systems can be used by everyone in healthcare from patients to clinicians to public health officials. Read the text in this image. . Friedman and Wyatt's table of nine generic study types describes similar ideas of incorporating users and tasks into the usability evaluation at certain system development time points.11 The stratified view of health IT usability evaluation extends the concept of evaluating with users and tasks to considering levels of user–task–system–environment interaction, as well as identifying confounding factors, task/expectation complexity, user variances, and organizational support, that directly or indirectly influence the results of usability evaluation. The inner ring has three main areas of work, Topics: User-centered design, Healthcare Published in: E Table 6 summarizes the usability study methods and number of studies at each stage of the SDLC. Degoulet Consequently, it is difficult to ascertain if a system issue is due to system–task interaction, user–system–task interaction or user–system–task–environment interaction. 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. The review includes studies published from 2003 to 2009. Theoretical frameworks/models are essential to research studies, suggesting rationale for hypothesized relationships and providing the basis for verification. Stein Vendors and hospital systems are both seeking out designers with relevant usability expertise. Marcial, L. (2014). Rahimi and Vimarlund10 reviewed general methods used to evaluate health IT. J Kossman Friedman Fitzhenry Rousseau et al. The motivation for adopting nursing information systems is often increased time for direct patient care.55 Researchers use time-and-motion studies to collect work activity information for time efficiency before and after using health IT.56 Two stage 4 studies in this literature review conducted randomized controlled trials to measure the efficiency of health IT.57,58 Although system impact is not the primary focus of stage 4, 32 studies assessed system utilization, patient outcomes, guideline adherence, and medication errors. Krones Patel K For evaluation goals, we used the usability aspects (efficiency, effectiveness, and satisfaction) suggested by ISO 9241. Norman The … This indicates a need for stratification of evaluation types; therefore, we defined goals based on the evaluation type being measured. Musen So, if a system was studied at different stages in different publications, it was included as one system with multiple evaluations. Usability design considers who the users are, what they know and how they learn, users' general backgrounds, and the context in which they use a given product. They are intended to help guide the designer on the fundamental tenets of design which help ensure proper usability. AMA Furthermore, ‘when to evaluate what’ answers the integrative question of evaluation timeline and focus. The first column indicates system development life cycle (SDLC) stages. Johnson For example, phenomenology, ethnography and ground theory are commonly used to understand users' experience, culture and decision-making process, respectively. Dourish At some time we are all likely to be patients. R Objective measures that researchers used at stage 3 included system validity (eg, accuracy and completeness) and efficiency (eg, speed and learnability). An evaluation using a Wizard-of-Oz experimental paradigm, Participatory Design: Principles and Practices. Just as a designer considers the difference between a first time user and a repeat user, designers who are new to the healthcare domain need to consider how this context represents some unique challenges. K For example, although helpful for medication management,18 barcode systems do not support free text to allow the entry of rich clinical data (change in task). et al. Michie Good usability of health information systems is critical for health information systems to be adopted and used efficiently. . Information Systems Training. Electronic Medical and Health Records: The Future of Healthcare Nursing Informatics Seanequa Morrison Dr. Gwen Morse November 22, 2016 Abstract Electronic medical records often used interchangeably with the term electronic health records are potential systems that are being used to not only transform the way healthcare is being delivered, but to promote the quality of care of patients … Nielsen Chin 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. 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. Table 5 summarizes the health IT types identified in the review. Evaluation types are the key to usability evaluation. Shahar Elhadad B User-centered design, where the user is centrally involved in all stages of the design process, is critical to improving the design of EHRs. KE et al. Methods include interview, focus group, and questionnaire. Achieving excellent usability in EHRs is daunting, given the information needs of administrative, financial and clinician groups. Khelifi 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. Therefore, we proposed an integrated usability specification and evaluation framework to combine the usability model of Bennett12 and Shackel13 and the SDLC into a comprehensive evaluation framework (table 2). WD However, the use of ICT to deliver safe and sustainable healthcare systems has been described as a “wicked problem,” referring to the complex web of stakeholders, systems, and legislative parameters involved. 2003. G Peute We also excluded studies evaluating methods or models because health IT usability evaluation was not their primary aim, and system demonstrations that had little or no information about health IT usability evaluation. . Ash Patel et al. A SE A guide based upon the framework is summarized in table 7. et al. 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. et al. Two additional methods59,60 that were not within our original search scope, but which were subsequently discovered are also included because of their potential value to health IT usability evaluation. Farlex Partner Medical Dictionary © Farlex 2012 In the U.S., the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act) established the Office of the National Coordinator for Health Information Technology (ONC). Titles and abstracts were first reviewed for inclusion. Interrelationships of Human Factors, Human Computer Interaction, and Ergonomics. Redish Health information systems consist of six key components, including: 1. This guide has the potential to assist researchers and those who develop and implement systems to design usability studies that are matched to specific system and evaluation goals. This participation in turn requires that consumers have access to good, reliable, trusted health information and the ability to comprehend and use this ... Information on the usability of these systems for diverse user groups is essential to the design and deployment of useful and usable PHR systems. Jalloh They collect data and compile it in a way that can be used to make healthcare decisions. Therefore, a system may meet all usability criteria for lower-level goals, such as task completion rate and performance speed, but may be unable to fulfil the requirements for higher-level goals, such as users' cognitive or physical workload and job satisfaction. Schnipper The research was supported by the Center for Evidence-based Practice in the Underserved (P30NR010677). Ammenwerth . The evaluation becomes more complicated in stages 4 and 5 with ‘type 4: user–task–system–environment’ interactions. Despite the proliferation of a range of information systems, there are continued reports of systems that have failed to be effectively adopted by end users and a lack of usability has been implicated in many of these cases. O'Meara Halbesleben . Therefore, it is of utmost importance to determine the usability of a system as soon as possible. Recent projects have investigated the impact of public health informatics initiatives on quality reporting through electronic health records and health information exchanges. F R The first column shows the five SDLC stages. Ahrenberg . Explication of the qualitative approach is important to determine study rigor with regard to criteria such as credibility, trust worthiness, and auditability. ... interoperability, usability and … However, it can be difficult to determine the efficiency of a healthcare information system, but the … Some common vocabulary standards currently used in the marketplace include: ... As the HIMSS definition suggests, interoperability goes beyond its technical requirements. MI This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (, A call to strengthen data in response to COVID-19 and beyond, Leveraging Conversational Technology to Answer Common COVID-19 Questions, Development of a “meta-model” to address missing data, predict patient-specific cancer survival and provide a foundation for clinical decision support, Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial, “A catalyst for action”: Factors for implementing clinical risk prediction models of infection in home care settings, About Journal of the American Medical Informatics Association, About the American Medical Informatics Association,,,,, Receive exclusive offers and updates from Oxford Academic, Cost-effectiveness of informatics and health IT: impact on finances and quality of care, C. Combination of components into a system, D. Integration of system into environment, The goals or subgoals of the user to the accuracy and completeness with which their goals can be achieved, The level of effectiveness achieved to the expenditure of resources, User attitude towards the use of the product, including both short-term and long-term measures (rate of absenteeism, health problem reports, or frequency of which users request transfer to another job), Needs assessments with design methods described, System validation evaluations, such as sensitivity and specificity examinations, ROC curve, and observer variation, Human–computer interaction evaluations focusing on outcome quality, user perception, and user performance in the laboratory setting, Field testing; experimental or quasi-experimental designs with control groups in one setting, Field testing; experimental or quasi-experimental designs with control groups in multiple sites; post-implementation evaluation only; self-control, such as evaluation before and after implementation, a. DM Usability of health information technology (health IT) systems means many things to many people. Inspired by Bennett and Shackel's usability model, the health IT usability specification and evaluation framework (table 2), which we adapted and applied in our review, provides a categorization of study approaches by evaluation types. C Five studies found in our literature review reported using cognitive walkthrough and think-aloud protocol;43–47 10 others used think-aloud only to determine if users were able accomplish tasks. Resourcesthe legislative, regulatory, and planning frameworks required for system functionality. Use chunking and emphasize key information at the beginning and end of interactive sequences. . CM Dumas Studies that focused on HCI in the laboratory setting, such as outcome quality, user perception, and user performance, were categorized as stage 3. . Rubin According to HIMSS, “usability is perhaps one of the most important factors hindering … RB You might not think of the people who design EHRs as stakeholders, but when so many systems must work together, the environment in which products are developed must be considered. (Courtesy HIMSS, Four studies facilitated the redesign process in order to improve existing systems.37–40 For example, one study used log files to identify the most frequent user activities and provided a list of popular queries and selected orders at the top of the pick-list for a more efficient computerized provider order entry system interface.39. 13. et al. P Physicians are more adherent to guideline recommendations when they are less familiar with the patient.75 However, greater adherence does not suggest better treatment, because additional knowledge beyond the electronic health record was found to be the major reason for non-adherence.76 Therefore, measuring guideline adherence rates may not capture pure usability; adjustments should be made for other confounders, such as familiarity with patients and physicians' experience. et al. There are different usability factors, which are expected to influence systems’ usability. .
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