Assessing the Usability of a Clinical Decision Support System: Heuristic Evaluation.
Assessing the Usability of a Clinical Decision Support System: Heuristic Evaluation.
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DOI：
10.2196/31758
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发表时间：
2022-05-10
影响因子：
2.7
通讯作者：
Lopez, Karen Dunn
中科院分区：
文献类型：
--
作者：
Cho, Hwayoung;Keenan, Gail;Madandola, Olatunde O.;Dos Santos, Fabiana Cristina;Macieira, Tamara G. R.;Bjarnadottir, Ragnhildur, I;Priola, Karen J. B.;Lopez, Karen Dunn
关键词：
易用性差是与使用电子健康记录(EHR)系统相关的意外后果的主要原因，这对患者安全产生了负面影响。由于进行迭代评估所需的成本和时间，许多电子病历组件，如临床决策支持系统(CDSS)，在部署到临床实践之前没有经过严格的可用性测试。部署前阶段的可用性测试对于消除可用性问题和防止在系统实施后发现这些问题时需要进行昂贵的修复至关重要。这项研究提供了一个系统评估方法的示例应用，该方法使用具有人机交互(HCI)专业知识的临床医生专家在随机对照试验中部署之前评估电子临床决策支持(CDS)干预的可用性。我们邀请了6名人机界面专家参与对我们的CDS干预的启发式评估。每名专家被要求独立探索干预至少两次。在使用患者情景完成分配的任务后，每个专家都完成了由Bright等人基于尼尔森的10个启发式方法开发的启发式评估核对表。专家们还对每个已识别的启发式违规的总体严重程度进行了评分，从0到4，其中0表示没有问题，4表示可用性灾难。综合来自专家编码评论的数据，并分析每个识别的可用性启发式的严重性。6名人机界面专家包括护理专业人员(n=4)、药学专家(n=1)和系统工程专业人员(n=1)。已识别的启发式违规的平均总体严重程度得分从0.66(使用的灵活性和效率)到2.00(用户控制、自由和错误预防)，其中得分接近0表示更可用的系统。用户控制和自由的启发式原则被认为是最需要改进的，特别是通过与非人机界面专家沟通，被认为存在重大的可用性问题。对于系统与现实世界之间的启发式匹配，专家们指出，与临床实践中常用的疼痛评分(通常为1=轻度疼痛)相比，我们系统的疼痛评分(1=重度疼痛)的方向相反；尽管这被确定为一个次要的可用性问题，但护理HCI专家一再强调其精细化。我们的启发式评估过程简单而系统，可用于系统开发的多个阶段，以减少在广泛实施之前建立系统可用性所需的时间和成本。此外，启发式评估可以帮助组织制定透明的可用性报告协议，正如21世纪治疗法案第四章所要求的那样。由在启发式评估过程中具有HCI专业知识的临床医生对EHR和CDSS进行测试，有可能在提高质量的同时减少测试的频率，这可能会减少临床医生的认知工作量和错误，并促进EHR和CDSS的采用。
Poor usability is a primary cause of unintended consequences related to the use of electronic health record (EHR) systems, which negatively impacts patient safety. Due to the cost and time needed to carry out iterative evaluations, many EHR components, such as clinical decision support systems (CDSSs), have not undergone rigorous usability testing prior to their deployment in clinical practice. Usability testing in the predeployment phase is crucial to eliminating usability issues and preventing costly fixes that will be needed if these issues are found after the system’s implementation. This study presents an example application of a systematic evaluation method that uses clinician experts with human-computer interaction (HCI) expertise to evaluate the usability of an electronic clinical decision support (CDS) intervention prior to its deployment in a randomized controlled trial. We invited 6 HCI experts to participate in a heuristic evaluation of our CDS intervention. Each expert was asked to independently explore the intervention at least twice. After completing the assigned tasks using patient scenarios, each expert completed a heuristic evaluation checklist developed by Bright et al based on Nielsen’s 10 heuristics. The experts also rated the overall severity of each identified heuristic violation on a scale of 0 to 4, where 0 indicates no problems and 4 indicates a usability catastrophe. Data from the experts’ coded comments were synthesized, and the severity of each identified usability heuristic was analyzed. The 6 HCI experts included professionals from the fields of nursing (n=4), pharmaceutical science (n=1), and systems engineering (n=1). The mean overall severity scores of the identified heuristic violations ranged from 0.66 (flexibility and efficiency of use) to 2.00 (user control and freedom and error prevention), in which scores closer to 0 indicate a more usable system. The heuristic principle user control and freedom was identified as the most in need of refinement and, particularly by nonnursing HCI experts, considered as having major usability problems. In response to the heuristic match between system and the real world, the experts pointed to the reversed direction of our system’s pain scale scores (1=severe pain) compared to those commonly used in clinical practice (typically 1=mild pain); although this was identified as a minor usability problem, its refinement was repeatedly emphasized by nursing HCI experts. Our heuristic evaluation process is simple and systematic and can be used at multiple stages of system development to reduce the time and cost needed to establish the usability of a system before its widespread implementation. Furthermore, heuristic evaluations can help organizations develop transparent reporting protocols for usability, as required by Title IV of the 21st Century Cures Act. Testing of EHRs and CDSSs by clinicians with HCI expertise in heuristic evaluation processes has the potential to reduce the frequency of testing while increasing its quality, which may reduce clinicians’ cognitive workload and errors and enhance the adoption of EHRs and CDSSs.
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影响因子：
3.5
作者：
Koskela T;Sandström S;Mäkinen J;Liira H
通讯作者：
Liira H
影响因子：
7.3
作者：
DAVIS, FD
通讯作者：
DAVIS, FD
影响因子：
3
作者：
Kutney-Lee A;Brooks Carthon M;Sloane DM;Bowles KH;McHugh MD;Aiken LH
通讯作者：
Aiken LH
DOI：
10.1016/j.ijmedinf.2008.10.002
发表时间：
2009-05-01
影响因子：
4.9
作者：
Jaspers, Monique W. M.
通讯作者：
Jaspers, Monique W. M.
影响因子：
1.4
作者：
Lopez, Karen Dunn;Febretti, Alessandro;Keenan, Gail
通讯作者：
Keenan, Gail