Debunking Health IT Usability Myths

N. Staggers; Y. Xiao; L. Chapman

doi:10.4338/ACI-2013-03-IE-0016

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2013; 04(02): 241-250
DOI: 10.4338/ACI-2013-03-IE-0016

Invited Editorial

Schattauer GmbH

Debunking Health IT Usability Myths

Authors

N. Staggers

¹School of Nursing, University of Maryland, Baltimore, MD.

²College of Nursing, University of Utah, Salt Lake City, UT
Y. Xiao

³Baylor Health Care System, Patient Safety Research, Dallas, Texas, United States
L. Chapman

⁴Macadamian, User Experience Research, Ottawa, Canada

Abstract

Summary

Poor usability is a threat to patient safety and linked to productivity loss, workflow disruption, user frustration, sub-optimal product use and system de-installations. Although usability is receiving more attention nationally and internationally, myths about usability persist. This editorial debunks five common myths about usability (1) usability only concerns the look and feel of a product and is, therefore, only a minor concern, (2) usability is not measurable, (3) usability stifles innovation, (4) vendors are solely responsible for product usability, and (5) usability methods are not practical for use in healthcare.

Keywords

Usability - user experience - human-computer interaction

Full Text

References

References
1 Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 4: 415-23. doi: M2373 [pii] 10.1197/jamia. M2373.
2 Ash JS, Sittig DF, Dykstra R, Campbell E, Guappone K. The unintended consequences of computerized provider order entry: findings from a mixed methods exploration. Int J Med Inform 2009: S69-76. doi: S1386-5056(08)00133-0 [pii] 10.1016/j.ijmedinf.2008.07.015.
3 Borycki E, Kushniruk A. Identifying and preventing technology-induced error using simulations: application of usability engineering techniques. Healthcare quarterly 2005: 99-105.
4 Borycki EM, Kushniruk A, Keay E, Nicoll J, Anderson J, Anderson M. Toward an integrated simulation approach for predicting and preventing technology-induced errors in healthcare: implications for health-care decision-makers. Healthcare quarterly 2009: 90-6.
5 CMS.. Certification Programs & Policy: 2014 Testing and Certification. http://www.healthit.gov/policy-re searchers-implementers/2014-testing-and-certification (April 18).
6 DOD.. Department of Defense Test Method Standard: Environment Engineering Considerations and Laboratory Tests. 2008
7 Drews FA, Westenskow DR. The right picture is worth a thousand numbers: data displays in anesthesia. Hum Factors 2006; 1: 59-71.
8 Dumas JS, Fox JE. Usability Testing: Current Practice and Future Directions. In: Sears A, Jacko J. (eds). The Human-Computer Interaction Handbook: Fundamentals, Evolving Technologies and Emerging Applications. New York: Lawrence Erlbaum; 2008
9 Elkin PL, Sorensen B, De Palo D, Poland G, Bailey KR, Wood DL, LaRusso NF. Optimization of a research web environment for academic internal medicine faculty. J Am Med Inform Assoc 2002; 5: 472-8.
10 FDA.. Medical Device Regulation Guidance. http://www.fda.gov/MedicalDevices/DeviceRegulationand Guidance/GuidanceDocuments/ucm259748.htm (April 25).
11 Guo J, Irdbarren S, Kapsandoy S, Perri S, Staggers N. eMAR User Interfaces: A Call for Ubiquitous Usability Evaluations and Product Redesign. Applied Clinical Informatics 2011; 2: 202-24.
12 HIMSS.. Promoting Usability in Health Organizations: Initial Steps and Progress Toward a Healthcare Usability Maturity Model Chicago, IL: Health Information Management Systems Society. 2011
13 HIMSS UT. Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating. (April 6).
14 Horsky J, Kuperman GJ, Patel VL. Comprehensive analysis of a medication dosing error related to CPOE. J Am Med Inform Assoc 2005; 4: 377-82. doi: 10.1197/jamia. M1740.
15 ISO.. Ergonomic requirements for office work with visual display terminals (VDTs) -- Part 11: Guidance on usability. International Organization for Standardization 1998
16 Jaspers MW. A comparison of usability methods for testing interactive health technologies: methodological aspects and empirical evidence. Int J Med Inform 2009; 5: 340-53. doi: 10.1016/j.ijmedinf.2008.10.002.
17 Kaber DB, Riley JM, Tan K-W. Improved usability of aviation automation through direct manipulation and graphical user interface design. The International Journal of Aviation 2002; 2: 153-78.
18 Karsh BT, Weinger MB, Abbott PA, Wears RL. Health information technology: fallacies and sober realities. J Am Med Inform Assoc 2010; 6: 617-23. doi: 10.1136/jamia.2010.005637.
19 Knowledge UBo. User experience. http://www.usabilitybok.org/glossary (April 18).
20 Koch S, Westenskow D, Weir C, Agutter J, Haar M, Gorges M, Liu D, Staggers N. ICU nurses’ evaluations of integrated information integration in displays for ICU nurses on user satisfaction and perceived mental workload. Medical Informatics Europe.; Pisa, Italy: 2012
21 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL. Role of computerized physician order entry systems in facilitating medication errors. Jama 2005; 10: 1197-203. doi: 10.1001/jama.293.10.1197.
22 Koppel R, Wetterneck T, Telles JL, Karsh BT. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc 2008; 4: 408-23. doi: 10.1197/jamia. M2616.
23 Kuniavsky M. Observing thre User Experience: A Practitioner’s Guide to User Research. San Francisco: Morgan Kaufmann Publishers (Elsevier); 2003
24 Kushniruk AW, Borycki EM. Low-cost rapid usability engineering: designing and customizing usable healthcare information systems. Healthcare quarterly 2006; 4: 98-100 2.
25 Kushniruk AW, Borycki EM, Kuwata S, Watanabe H. Using a low-cost simulation approach for assessing the impact of a medication administration system on workflow. Stud Health Technol Inform 2008: 567-72.
26 Kushniruk AW, Bates DW, Bainbridge M, Househ MS, Borycki EM. National efforts to improve health information system safety in Canada, the United States of America and England. Int J Med Inform. 2013 doi: 10.1016/j.ijmedinf.2012.12.006.
27 Laurel B. The Art of Human-Computer Interface Design. Reading, MA: Addison-Wesley Publishing Company, Inc.; 1990
28 Lazar J, Feng JH, Hochheiser H. Research Methods in Human-Computer Interaction. West Sussex, England: John Wiley and Sons, Ltd.; 2010
29 Li AC, Kannry JL, Kushniruk A, Chrimes D, McGinn TG, Edonyabo D, Mann DM. Integrating usability testing and think-aloud protocol analysis with "near-live" clinical simulations in evaluating clinical decision support. Int J Med Inform 2012; 11: 761-72. doi: 10.1016/j.ijmedinf.2012.02.009.
30 Linde C, Shively RJ. Field study of communciation and workload in poice helicopters: Implications for AI cockpit design. Human Factors and Ergonomics Society Annual Meeting. 1988
31 Lowry SZ, Quinn MT, Ramaiah M, Schumacher RM, Patterson EM, North R, Zhang J, Gibbons MC, Abbott PA. Technical Evaluation, Testing and Validiation of the Usability of Electronic Health Records. Rockville, MD: National Institute of Standards and Technology; 2012
32 McDonnell C, Werner K, Wendell L. Electronic Health Record Usability: Vendor Practices and Perspectives. Rockville, MD; 2010
33 Medicine IIo. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D. C.: The National Academies Press; 2011. Washington, D. C. 2011.
34 Nebeker JR, Hoffman JM, Weir CR, Bennett CL, Hurdle JF. High rates of adverse drug events in a highly computerized hospital. Archives of internal medicine 2005; 10: 1111-6. doi: 10.1001/archinte.165.10.1111.
35 Nielsen J. Usability Engineering. Cambridge, MA: AP Professional; 1993
36 Nielsen J. What is Usability?. In: Usability Engineering. San Francisco, CA: Morgan Kaufmann Publishers; 1993: 23-48.
37 Nielsen J. Discount Usability: 20 Years. http://www.useit.com/alertbox/discount-usability.html (February 15, 2010).
38 NRC U. Human Factors. http://www.nrc.gov/reactors/operating/ops-experience/human-factors.html (April).
39 Rubin J, Chisnell D. Handbook of Usability Testing: How to Plan, Design and Conduct Effective Tests. 2008. New York: John Wiley & Sons; 2008
40 Russ AL, Weiner M, Russell SA, Baker DA, Fahner WJ, Saleem JJ. Design and implementation of a hospital-based usability laboratory: insights from a Department of Veterans Affairs laboratory for health information technology. Joint Commission journal on quality and patient safety / Joint Commission Resources 2012; 12: 531-40.
41 Saleem JJ, Patterson ES, Militello L, Anders S, Falciglia M, Wissman JA, Roth EM, Asch SM. Impact of clinical reminder redesign on learnability, efficiency, usability, and workload for ambulatory clinic nurses. J Am Med Inform Assoc 2007; 5: 632-40. doi: 10.1197/jamia. M2163.
42 Saleem JJ, Russ AL, Neddo A, Blades PT, Doebbeling BN, Foresman BH. Paper persistence, workarounds, and communication breakdowns in computerized consultation management. International Journal of Medical Informatics 2011; 7: 466-79. doi: 10.1016/j.ijmedinf.2011.03.016.
43 Schultz J. Spotlight on innovation. Harvard Business Review. 2011 June.
44 Schumacher RM, Lowry SZ. Customized Common Industry Format Template for Electronic Health Record Usability Testing. Rockville, MD: National Insitutes of Standards and Technology; 2010
45 Schumacher RM, Lowry SZ. NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records. NIST Interagency/Internal Report. Rockville, MD: National Institute of Standards and Technology; 2010
46 Sherry L, Polson P, Feary M. Designing user-interfaces for the cockpit: Five common design errors and how to avoid them. 2001.
47 Silver JD, Hammil SD. Doctor, nurse disciplined by UPMC in kidney transplant case: Failed to detect hepatitis C in kidney donated for transplant. Pittsburg Post Gazette.; Pittsburg, PA: 2011
48 Staggers N, Kobus D. Comparing response time, errors, and satisfaction between text-based and graphical user interfaces during nursing order tasks. J Am Med Inform Assoc 2000; 2: 164-76.
49 Staggers N, Jennings BM, Lasome CE. A usability assessment of AHLTA in ambulatory clinics at a military medical center. Mil Med 2010; 7: 518-24.
50 Staggers N, Clark L, Blaz JW, Kapsandoy S. Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: insights from interviews and observations. Health Informatics J 2011; 3: 209-23. doi: 17/3/209 [pii] 10. 1177/1460458211405809.
51 Stead W, Lin H. Computational Technology for Effective Healthcare: Immediate Steps and Strategic Directions. Washington, D. C.: National Academies Press; 2009
52 Tullis T, Albert B. Measuring the User Experience: Collecting, Analyzing and Presenting Usability Metrics. New York: Elseiver; 2008
53 Viitanen J, Hypponen H, Laaveri T, Vanska J, Reponen J, Winblad I. National questionnaire study on clinical ICT systems proofs: physicians suffer from poor usability. Int J Med Inform 2011; 10: 708-25. doi: 10.1016/j.ijmedinf.2011.06.010.
54 Wachter SB, Johnson K, Albert R, Syroid N, Drews F, Westenskow D. The evaluation of a pulmonary display to detect adverse respiratory events using high resolution human simulator. J Am Med Inform Assoc 2006; 6: 635-42. doi: M2123 [pii] 10.1197/jamia. M2123.
55 Wears RL, Nemeth CP. Replacing hindsight with insight: toward better understanding of diagnostic failures. Annals of emergency medicine 2007; 2: 206-9. doi: 10.1016/j.annemergmed.2006.08.027.
56 Xiao Y. Artifacts and collaborative work in healthcare: methodological, theoretical, and technological implications of the tangible. Journal of biomedical informatics 2005; 1: 26-33. doi: 10.1016/j.jbi.2004.11.004.