Appl Clin Inform 2013; 04(02): 276-292
DOI: 10.4338/ACI-2012-09-RA-0034
Research Article
Schattauer GmbH

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

Factors affecting ease of use, efficiency, and entry error
D. B. Herrick*
1  Johns Hopkins University School of Medicine, Department of Neurology
,
A. Nakhasi*
2  Johns Hopkins University School of Medicine
,
B. Nelson
3  Johns Hopkins University
,
S. Rice
1  Johns Hopkins University School of Medicine, Department of Neurology
,
P. A. Abbott
4  Johns Hopkins University School of Nursing
,
A. S. Saber Tehrani
1  Johns Hopkins University School of Medicine, Department of Neurology
,
R. E. Rothman
5  Johns Hopkins University School of Medicine, Department of Emergency Medicine
,
H. P. Lehmann
6  Johns Hopkins University School of Medicine, Division of Health Sciences Informatics
,
D. E. Newman-Toker
1  Johns Hopkins University School of Medicine, Department of Neurology
› Author Affiliations
Further Information

Correspondence to:

David E. Newman-Toker
Johns Hopkins Hospital
Meyer 8–154
600 North Wolfe Street
Baltimore, MD 21287
Email: toker@jhu.edu   
Phone: 410–502–6270   
Fax: 410–502–6265

Publication History

received: 12 September 2012

accepted: 01 June 2013

Publication Date:
19 December 2017 (online)

 

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.


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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



Correspondence to:

David E. Newman-Toker
Johns Hopkins Hospital
Meyer 8–154
600 North Wolfe Street
Baltimore, MD 21287
Email: toker@jhu.edu   
Phone: 410–502–6270   
Fax: 410–502–6265