Software prototypingA case report of refining user requirements for a health information exchange dashboardWe would like to thank Frank Drews, PhD for his help and review. This study was funded by the US Agency for Healthcare Research & Quality (1 R01 HS021472–01A1). At the time of this study, Dr. Nelson was supported by the VA Advanced Fellowship Program in Medical Informatics of the Office of Academic Affiliations, Department of Veterans Affairs. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
28 July 2015
accepted: 12 January 2015
16 December 2017 (online)
Health information exchange (HIE) between Poison Control Centers (PCCs) and Emergency Departments (EDs) could improve care of poisoned patients. However, PCC information systems are not designed to facilitate HIE with EDs; therefore, we are developing specialized software to support HIE within the normal workflow of the PCC using user-centered design and rapid prototyping.
To describe the design of an HIE dashboard and the refinement of user requirements through rapid prototyping.
Using previously elicited user requirements, we designed low-fidelity sketches of designs on paper with iterative refinement. Next, we designed an interactive high-fidelity prototype and conducted scenario-based usability tests with end users. Users were asked to think aloud while accomplishing tasks related to a case vignette. After testing, the users provided feedback and evaluated the prototype using the System Usability Scale (SUS).
Survey results from three users provided useful feedback that was then incorporated into the design. After achieving a stable design, we used the prototype itself as the specification for development of the actual software. Benefits of prototyping included having 1) subject-matter experts heavily involved with the design; 2) flexibility to make rapid changes, 3) the ability to minimize software development efforts early in the design stage; 4) rapid finalization of requirements; 5) early visualization of designs; 6) and a powerful vehicle for communication of the design to the programmers. Challenges included 1) time and effort to develop the prototypes and case scenarios; 2) no simulation of system performance; 3) not having all proposed functionality available in the final product; and 4) missing needed data elements in the PCC information system.
- 1 Injury Facts, 2012 Edition. Itasca, IL: National Safety Council; 2012
- 2 Friedman LS, Krajewski A, Vannoy E, Allegretti A, Wahl M. The association between U.S. Poison Center assistance and length of stay and hospital charges. Clin Toxicol (Phila) 2014; 52 (03) 198-206 doi: 10.3109/15563650.2014.892125. PubMed PMID: 24580060.
- 3 LoVecchio F, Curry S, Waszolek K, Klemens J, Hovseth K, Glogan D. Poison control centers decrease emergency healthcare utilization costs. J Med Toxicol 2008; 04 (04) 221-224 PubMed PMID: 19031372; PubMed Central PMCID: PMC3550108.
- 4 Cummins MR, Crouch B, Gesteland P, Wyckoff A, Allen T, Muthukutty A, Palmer R, Peelay J, Repko K. Inefficiencies and vulnerabilities of telephone-based communication between U. S. poison control centers and emergency departments. Clin Toxicol (Phila) 2013; 51 (05) 435-443 Epub 2013/05/24. doi: 10.3109/15563650.2013.801981. PubMed PMID: 23697459.
- 5 Vassilev ZP, Kashani J, Ruck B, Hoffman RS, Marcus SM. Poison control center surge capacity during an unusual increase in call volume – results from a natural experiment. Prehosp Disaster Med 2007; 22 (01) 55-58 PubMed PMID: 17484364.
- 6 Caravati EM, Latimer S, Reblin M, Bennett HK, Cummins MR, Crouch BI, Ellington L. High call volume at poison control centers: identification and implications for communication. Clin Toxicol (Phila) 2012; 50 (08) 781-787 doi: 10.3109/15563650.2012.713968. PubMed PMID: 22889059.
- 7 Del Fiol G, Crouch BI, Cummins MR. Data standards to support health information exchange between poison control centers and emergency departments. J Am Med Inform Assoc. 2014 doi: 10.1136/amiajnl-2014–003127. PubMed PMID: 25342180.
- 8 Cummins MR, Crouch BI, Gesteland P, Staggers N, Wyckoff A, Wong BG. Electronic information exchange between emergency departments and poison control centers: a Delphi study. Clin Toxicol (Phila) 2012; 50 (06) 503-513 Epub 2012/05/23. doi: 10.3109/15563650.2012.693183. PubMed PMID: 22612793.
- 9 Gould DJ, Terrell MA, Fleming J. A usability study of users’ perceptions toward a multimedia computer-assisted learning tool for neuroanatomy. Anat Sci Educ 2008; 01 (04) 175-183 doi: 10.1002/ase.36. PubMed PMID: 19177405; PubMed Central PMCID: PMCPMC4532302.
- 10 Johnson KB. Barriers that impede the adoption of pediatric information technology. Arch Pediatr Adolesc Med 2001; 155 (12) 1374-1379 PubMed PMID: 11732959.
- 11 Verhoeven F, Steehouder MF, Hendrix RM, van Gemert-Pijnen JE. Factors affecting health care workers’ adoption of a website with infection control guidelines. Int J Med Inform 2009; 78 (10) 663-678 doi: 10.1016/j.ijmedinf.2009.06.001. PubMed PMID: 19577956.
- 12 Weir CR, Crockett R, Gohlinghorst S, McCarthy C. Does user satisfaction relate to adoption behavior?: an exploratory analysis using CPRS implementation. Proc AMIA Symp 2000; 913-917 PubMed PMID: 11080017; PubMed Central PMCID: PMCPMC2243831.
- 13 Fairbanks RJ, Caplan S. Poor interface design and lack of usability testing facilitate medical error. Jt Comm J Qual Saf 2004; 30 (10) 579-584 PubMed PMID: 15518362.
- 14 Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med 2003; 348 (25) 2526-2534 Epub 2003/06/20. doi: 10.1056/NEJMsa020847. PubMed PMID: 12815139.
- 15 Horsky J, Kuperman GJ, Patel VL. Comprehensive analysis of a medication dosing error related to CPOE. J Am Med Inform Assoc 2005; 12 (04) 377-382 doi: 10.1197/jamia.M1740. PubMed PMID: 15802485; PubMed Central PMCID: PMC1174881.
- 16 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; 293 (10) 1197-1203 doi: 10.1001/jama.293.10.1197. PubMed PMID: 15755942.
- 17 Brown S, Holzinger A. editors Low cost prototyping: Part 1, or how to produce better ideas faster by getting user reactions early and often. Proceedings of the 22nd British HCI Group Annual Conference on People and Computers: Culture, Creativity, Interaction-Volume 2. 2008. British Computer Society.;
- 18 Heaton N. editor What’s wrong with the user interface: How rapid prototyping can help. Software Prototyping and Evolutionary Development, IEE Colloquium on. 1992. IET.;
- 19 Johnson J. Designing with the mind in mind: Simple guide to understanding user interface design rules. Morgan Kaufmann; 2010
- 20 Vincent CJ, Blandford A. Usability standards meet scenario-based design: Challenges and opportunities. J Biomed Inform. 2014 doi: 10.1016/j.jbi.2014.11.008. PubMed PMID: 25460202.
- 21 Nelson S, Del Fiol G, Hanseler H, Crouch B, Cummins M. A dashboard for health information exchange between poison control centers and emergency departments: the poison control center view. 2014 Annual Meeting of the North American Congress of Clinical Toxicology (NACCT). Oct 2014. New Orleans, LA: Clin Toxicol 2014; 682-818.
- 22 Jaspers MW. A comparison of usability methods for testing interactive health technologies: methodological aspects and empirical evidence. Int J Med Inform 2009; 78 (05) 340-353 doi: 10.1016/j.ijme-inf.2008.10.002. PubMed PMID: 19046928.
- 23 Zhang J, Walji MF. TURF: toward a unified framework of EHR usability. J Biomed Inform 2011; 44 (06) 1056-1067 Epub 2011/08/27. doi: 10.1016/j.jbi.2011.08.005. PubMed PMID: 21867774.
- 24 Brooke J. SUS-A quick and dirty usability scale. Usability evaluation in industry. 1996. 189 194.
- 25 Nielsen J. Estimating the number of subjects needed for a thinking aloud test. International journal of human-computer studies 1994; 41 (03) 385-397.
- 26 Nelson SD, Del Fiol G, Hanseler H, Crouch B, Cummins M. A dashboard for health information exchange between poison control centers and emergency departments: the poison control center view. Clin Toxicol 2014; 52: 682-818.
- 27 Del Fiol G, Crouch BI, Cummins MR. Data standards to support health information exchange between poison control centers and emergency departments. J Am Med Inform Assoc 2015; 22 (03) 519-528 doi: 10.1136/amiajnl-2014–003127. PubMed PMID: 25342180.
- 28 Nielsen J. Paper versus computer implementations as mockup scenarios for heuristic evaluation. Proceedings of the IFIP TC13 Third Interational Conference on Human-Computer Interaction. 725312. North-Holland Publishing Co; 1990: 315-320.
- 29 Tetzlaff L, Schwartz DR. The use of guidelines in interface design. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. New Orleans, Louisiana, USA. 108936: ACM; 1991: 329-33.
- 30 Rudd J, Stern K, Isensee S. Low vs. high-fidelity prototyping debate. interactions. 1996; 03 (01) 76-85.
- 31 Humayoun SR, Hess S, Kiefer F, Ebert A. editors i2ME: a framework for building interactive mockups. Proceedings of the 15th international conference on Human-computer interaction with mobile devices and services. 2013. ACM.;
- 32 Ko Y-j, Jung H, Kim E, Keum E. Suggestions of Prototyping Tool for Service Design Co-Creation. Focusing on Mobile Application. 2013
- 33 Saitwal H, Feng X, Walji M, Patel V, Zhang J. Assessing performance of an Electronic Health Record (EHR) using Cognitive Task Analysis. Int J Med Inform 2010; 79 (07) 501-506 doi: 10.1016/j.ijmedinf.2010.04.001. PubMed PMID: 20452274.
- 34 Bhutkar G, Konkani A, Katre D, Ray GG. A review: healthcare usability evaluation methods. Biomed Instrum Technol 2013; Suppl: 45-53 doi: 10.2345/0899–8205–47.s2.45. PubMed PMID: 24111771.
- 35 Vijayan J, Raju G. Requirements Elicitation Using Paper Prototype. Advances in Software Engineering. Springer; 2010: 30-37.
- 36 Zhang J, Chung J-Y. Mockup-driven fast-prototyping methodology for Web application development. Software: Practice and Experience 2003; 33 (13) 1251-1272 doi: 10.1002/spe.547.
- 37 Virzi RA, Sokolov JL, Karis D. editors Usability problem identification using both low-and high-fidelity prototypes. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. 1996. ACM.;
- 38 Cummins M, Crouch B, Del Fiol G, Mateos B, Muthukutty A, Wyckoff A. Information Requirements for Health Information Exchange Supported Communication between Emergency Departments and Poison Control Centers. AMIA Annu Symp Proc 2014; 449-456.
- 39 Kahneman D. Thinking Fast and Slow. New York: Ferrar, Straus and Giroux; 2011
- 40 Smith ER, DeCoster J. Dual-Process Models in Social and Cognitive Psychology: Conceptual Integration and Links to Underlying Memory Systems. Personality and Social Psychology Review 2000; 04 (02) 108-131.
- 41 Croskerry P. Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Advances in health sciences education 2009; 14 (01) 27-35.
- 42 Cooke L, Cuddihy E. editors Using eye tracking to address limitations in think-aloud protocol. Professional Communication Conference, 2005 IPCC 2005 Proceedings International. 2005. IEEE.;
- 43 Borycki E, Kushniruk A. Identifying and preventing technology-induced error using simulations: application of usability engineering techniques. Healthc Q 2005; 8 Spec No: 99-105. PubMed PMID: 16334081.
- 44 Cummins M, Crouch B, Del Fiol G, Greene T, Allen T, Naurs S. Electronic Exchange of poisoning Information AHRQ 1R01HS021472-01A1. Salt Lake City; UT: 2013