Appl Clin Inform 2019; 10(04): 693-706
DOI: 10.1055/s-0039-1695800
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Design and Evaluation of an Integrated, Patient-Focused Electronic Health Record Display for Emergency Medicine

Xiaomei Wang
1  Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
,
Tracy C. Kim
2  National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
,
Sudeep Hegde
1  Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
,
Daniel J. Hoffman
2  National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
,
Natalie C. Benda
2  National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
,
Ella S. Franklin
2  National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
,
David Lavergne
3  Smart Information Flow Technologies, Minneapolis, Minnesota, United States
,
Shawna J. Perry
4  Department of Emergency Medicine, University of Florida, Jacksonville, Florida, United States
,
Rollin J. Fairbanks
2  National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
,
A. Zachary Hettinger
2  National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
,
Emilie M. Roth
5  Roth Cognitive Engineering, Stanford, California, United States
,
Ann M. Bisantz
1  Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
› Author Affiliations
Funding This study was funded by the Agency for Healthcare Research and Quality's (AHRQ) R01 grant (R01HS022542).
Further Information

Publication History

12 March 2019

12 July 2019

Publication Date:
18 September 2019 (online)

Abstract

Background Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care.

Objective This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses.

Methods ED nurse and provider participants were presented various scenarios requiring patient-prioritization and care-planning tasks to be performed using the prototype display. Participants rated the display in terms of its cognitive support, usability, and usefulness. Participants' performance on the various tasks, and their feedback on the display design and utility, was analyzed.

Results Participants provided ratings for usability and usefulness for the display sections using a work-centered usability questionnaire—mean scores for nurses and providers were 7.56 and 6.6 (1 being lowest and 9 being highest), respectively. General usability scores, based on the System Usability Scale tool, were rated as acceptable or marginally acceptable. Similarly, participants also rated the display highly in terms of support for specific cognitive objectives.

Conclusion A novel patient-focused status display for emergency medicine was evaluated via a simulation-based study in terms of work-centered usability and usefulness. Participants' subjective ratings of usability, usefulness, and support for cognitive objectives were encouraging. These findings, including participants' qualitative feedback, provided insights for improving the design of the display.

Protection of Human and Animal Subjects

This study protocol was reviewed and approved by the lead author's Institutional Review Board (IRB), which also served as the IRB of Record for coauthors belonging to other institutions. Participants provided verbal consent to participate in the study.