Usability characteristics of self-administered computer-assisted interviewing in the emergency department

Summary

Objective: Self-administered computer-assisted interviewing (SACAI) gathers accurate information from patients and could facilitate Emergency Department (ED) diagnosis. As part of an ongoing research effort whose long-range goal is to develop automated medical interviewing for diagnostic decision support, we explored usability attributes of SACAI in the ED.

Methods: Cross-sectional study at two urban, academic EDs. Convenience sample recruited daily over six weeks. Adult, non-level I trauma patients were eligible. We collected data on ease of use (self-reported difficulty, researcher documented need for help), efficiency (mean time-per-click on a standardized interview segment), and error (self-report age mismatched with age derived from electronic health records) when using SACAI on three different instruments: Elo TouchSystems ESY15A2 (finger touch), Toshiba M200 (with digitizer pen), and Motion C5 (with digitizer pen). We calculated descriptive statistics and used regression analysis to evaluate the impact of patient and computer factors on time-per-click.

Results: 841 participants completed all SACAI questions. Few (<1%) thought using the touch computer to ascertain medical information was difficult. Most (86%) required no assistance. Participants needing help were older (54 ± 19 vs. 40 ± 15 years, p<0.001) and more often lacked internet at home (13.4% vs. 7.3%, p = 0.004). On multivariate analysis, female sex (p<0.001), White (p<0.001) and other (p = 0.05) race (vs. Black race), younger age (p<0.001), internet access at home (p<0.001), high school graduation (p = 0.04), and touch screen entry (vs. digitizer pen) (p = 0.01) were independent predictors of decreased time-per-click. Participant misclick errors were infrequent, but, in our sample, occurred only during interviews using a digitizer pen rather than a finger touch-screen interface (1.9% vs. 0%, p = 0.09).

Discussion: Our results support the facility of interactions between ED patients and SACAI. Demographic factors associated with need for assistance or slower interviews could serve as important triggers to offering human support for SACAI interviews during implementation.

Conclusion: Understanding human-computer interactions in real-world clinical settings is essential to implementing automated interviewing as means to a larger long-term goal of enhancing clinical care, diagnostic accuracy, and patient safety.

Citation: Herrick DB, Nakhasi A, Nelson B, Rice S, Abbott PA, Tehrani ASS, Rothman RE, Lehmann HP, NewmanToker DE. Usability characteristics of self-administered computer-assisted interviewing in the emergency department. Factors affecting ease of use, efficiency, and entry error.

Keywords

Medical history taking - computer assisted diagnosis - clinical decision-support systems - point of care systems - triage

 

Conflict of Interest Statement

No conflicts of interest. None of the authors have any financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work.

^* These authors request co-first authorship

• References

• 1 Newman-Toker DE, Pronovost PJ. Diagnostic errors the next frontier for patient safety. JAMA 2009; 301 (10) 1060-1062.
• 2 Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL. et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med 2009; 169 (20) 1881-1887.
• 3 Kovacs G, Croskerry P. Clinical decision making: an emergency medicine perspective. AcadEmergMed 1999; 6 (09) 947-952.
• 4 Schwartz LR, Overton DT. Emergency department complaints: a one-year analysis. Ann Emerg Med 1987; 16 (08) 857-861.
• 5 Trautlein JJ, Lambert RL, Miller J. Malpractice in the emergency department--review of 200 cases. Ann Emerg Med 1984; 13 9 Pt 1 709-711.
• 6 Miller RA. Medical diagnostic decision support systems--past, present, and future: a threaded bibliography and brief commentary. J Am Med Inform Assoc 1994; 1 (01) 8-27.
• 7 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. Bmj 2005; 330 7494 765.
• 8 Benaroia M, Elinson R, Zarnke K. Patient-directed intelligent and interactive computer medical history-gathering systems: a utility and feasibility study in the emergency department. Int J Med Inform 2007; 76 (04) 283-288.
• 9 Hess R, Santucci A, McTigue K, Fischer G, Kapoor W. Patient difficulty using tablet computers to screen in primary care. J Gen Intern Med 2008; 23 (04) 476-480.
• 10 Wolford G, Rosenberg SD, Rosenberg HJ, Swartz MS, Butterfield MI, Swanson JW. et al. A clinical trial comparing interviewer and computer-assisted assessment among clients with severe mental illness. Psychiatr Serv 2008; 59 (07) 769-775.
• 11 Acheson LS, Zyzanski SJ, Stange KC, Deptowicz A, Wiesner GL. Validation of a self-administered, computerized tool for collecting and displaying the family history of cancer. J Clin Oncol 2006; 24 (34) 5395-5402.
• 12 Langhaug LF, Sherr L, Cowan FM. How to improve the validity of sexual behaviour reporting: systematic review of questionnaire delivery modes in developing countries. Trop Med Int Health 2010; 15 (03) 362-381.
• 13 Dugaw Jr. JE, Civello K, Chuinard C, Jones GN. Will patients use a computer to give a medical history?. J Fam Pract 2000; 49 (10) 921-923.
• 14 Porter SC, Silvia MT, Fleisher GR, Kohane IS, Homer CJ, Mandl KD. Parents as direct contributors to the medical record: validation of their electronic input. Ann Emerg Med 2000; 35 (04) 346-352.
• 15 Porter SC, Kohane IS, Goldmann DA. Parents as partners in obtaining the medication history. JAm Med InformAssoc 2005; 12 (03) 299-305.
• 16 Porter SC, Manzi SF, Volpe D, Stack AM. Getting the data right: information accuracy in pediatric emergency medicine. Qual Saf Health Care 2006; 15 (04) 296-301.
• 17 Porter SC, Forbes P, Manzi S, Kalish LA. Patients providing the answers: narrowing the gap in data quality for emergency care. Qual Saf Health Care 2010; 19 (05) e34.
• 18 Fine AM, Kalish LA, Forbes P, Goldmann D, Mandl KD, Porter SC. Parent-driven technology for decision support in pediatric emergency care. Jt Comm J Qual Patient Saf. 2009; 35 (06) 307-315.
• 19 Porter SC, Fleisher GR, Kohane IS, Mandl KD. The value of parental report for diagnosis and management of dehydration in the emergency department. Ann Emerg Med 2003; 41 (02) 196-205.
• 20 Bourgeois FT, Porter SC, Valim C, Jackson T, Cook EF, Mandl KD. The value of patient self-report for disease surveillance. J Am Med Inform Assoc 2007; 14 (06) 765-771.
• 21 Sawyer MA, Lim RB, Wong SY, Cirangle PT, Birkmire-Peters D. Telementored laparoscopic cholecystectomy: a pilot study. Stud Health Technol Inform 2000; 70: 302-308.
• 22 Abbott PA. The effectiveness and clinical usability of a handheld information appliance. Nurs Res Pract 2012; 307258.
• 23 Schwartz RJ, Weiss KM, Buchanan AV. Error control in medical data. MD Comput 1985; 2 (02) 19-25.
• 24 Tang P, McDonald C. Electronic health record systems. In: Shortliffe E, Cimino J. editors. Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Health Informatics). New York: 2006. p. 466.
• 25 McCaig L, Burt C. National Hospital Ambulatory Medical Care Survey: 2003 emergency department summary. Hyattsville, Maryland: National Center for Health Statistics; 2005
• 26 Zeiss B, Vega D, Schieferdecker I, Neukirchen H, Grabowski J. Applying the ISO 9126 quality nodel to test specifications. Kurzbeiträge: 2007
• 27 National Hospital Ambulatory Medical Care Survey:2010 Emergency Department Summary Tables. 2010 Available from: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf. Accessed March 27, 2013.
• 28 The Nielson Company.. Six million more seniors using the web than five years ago. 2009 [cited 2010 October]; Available from: http://blog.nielsen.com/nielsenwire/online_mobile/six-million-more-seniors-using-the-web-than-five-years-ago.
• 29 Wells J, Lewis L. Internet Access in U. S. Public Schools and Classrooms: 1994–2005 (NCES 2007-020). Washington, DC: U. S. Department of Education,; 2006
• 30 Fisher R. Social desirability bias and the validity of indirect questioning. Journal of Consumer Research 1993; 20 (02) 303-315.