A mixed-methods evaluation framework for electronic health records usability studies
A mixed-methods evaluation framework for electronic health records usability studies
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DOI：
10.1016/j.jbi.2019.103175
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发表时间：
2019-06-01
影响因子：
4.5
通讯作者：
Carson, Shannon S.
中科院分区：
文献类型：
--
作者：
Khairat, Saif;Coleman, Cameron;Carson, Shannon S.
背景资料：不良的EHR设计增加了进一步的挑战，特别是在订单输入和信息可视化方面，其净效应是ICU环境中事件、事故和死亡率的增加。目的：本研究的目的是提出一种新的混合方法框架，通过识别和表征基于供应商的方法：在美国东南部的一个单一的、大型的、三级学术医疗中心利用商业的、基于供应商的EHR进行混合方法的、现场观察的可用性研究。医生被要求完成可用性患者的情况下，提供三个调查的响应，并在一个半结构化的interview.Results：在25名注册ICU医生参与者，有5（20%）主治医生，9（36%）研究员，和11（44%）居民; 52%的参与者是女性。平均而言，住院医生完成任务的速度最快，而主治医生完成相同任务的时间最长。可用性差，界面屏幕复杂，难以浏览EHR与高挫折感水平显著相关。显着的关联被发现之间的错误消息的发生和时间的需求，使更多的错误消息导致更长的完成时间（p = .03）。讨论：医生仍然感到沮丧的EHR由于难以找到病人的信息。EHR可用性仍然是医疗保健领域的一个关键挑战，对医疗错误，患者安全和临床医生倦怠都有影响。有必要对当前的信息需求和改善与EHR相关的信息过载的方法进行科学研究。
Background: Poor EHR design adds further challenges, especially in the areas of order entry and information visualization, with a net effect of increased rates of incidents, accidents, and mortality in ICU settings.Objective: The purpose of this study was to propose a novel, mixed-methods framework to understand EHR-related information overload by identifying and characterizing areas of suboptimal usability and clinician frustration within a vendor-based, provider-facing EHR interface.Methods: A mixed-methods, live observational usability study was conducted at a single, large, tertiary academic medical center in the Southeastern US utilizing a commercial, vendor based EHR. Physicians were asked to complete usability patient cases, provide responses to three surveys, and participant in a semi-structured interview.Results: Of the 25 enrolled ICU physician participants, there were 5(20%) attending physicians, 9 (36%) fellows, and 11 (44%) residents; 52% of participants were females. On average, residents were the quickest in completing the tasks while attending physician took the longest to complete the same task. Poor usability, complex interface screens, and difficulty to navigate the EHR significantly correlated with high frustration levels. Significant association were found between the occurrence of error messages and temporal demand such that more error messages resulted in longer completion time (p = .03).Discussion: Physicians remain frustrated with the EHR due to difficulty in finding patient information. EHR usability remains a critical challenge in healthcare, with implications for medical errors, patient safety, and clinician burnout. There is a need for scientific findings on current information needs and ways to improve EHRrelated information overload.