Comparing Electronic Health Record Usability of Primary Care Physicians by Clinical Year

Martina A. Clarke, Jeffery L. Belden, Min Soon Kim

2016

Abstract

Objectives: To examine usability gaps among primary care resident physicians by clinical year: year 1 (Y1), year 2 (Y2), and year 3 (Y3) when using electronic health record (EHR). Methods: Twenty-nine usability tests with video analysis were conducted involving triangular method approach. Performance metrics of percent task success rate, time on task, and mouse activities were compared along with subtask analysis among the three physician groups. Results: Our findings showed comparable results for physicians of all three years in mean performance measures, specifically task success rate (Y1: 95%, Y2: 98%, Y3: 95%). However, varying usability issues were identified among physicians from all three clinical years. Twenty-nine common usability issues across five themes emerged during sub task analysis: inconsistencies, user interface issues, structured data issues, ambiguous terminologies, and workarounds. Discussion and Conclusion: This study identified varying usability issues for users of the EHR with different experience level, which may be used to potentially increase physicians’ performance when using an EHR. While three physician groups showed comparable performance metrics, these groups encountered numerous usability issues that should be addressed for effective EHR training and patient care.

References

  1. Braun, V. & Clarke, V. 2006. Using thematic analysis in psychology. Qualitative research in psychology, 3, 77- 101.
  2. Brooke, J. 1996. SUS-A quick and dirty usability scale. Usability Evaluation in Industry, 189, 194.
  3. Carr, D. M. 2004. A team approach to EHR implementation and maintenance. Nurs Manage, 35 Suppl 5, 15-6, 24.
  4. Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., Morton, S. C. & Shekelle, P. G. 2006. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med, 144, 742-52.
  5. Clarke, M. A., Belden, J. L. & Kim, M. S. 2015. What Learnability Issues Do Primary Care Physicians Experience When Using CPOE? In: KUROSU, M. (ed.) Human-Computer Interaction: Users and Contexts. Springer International Publishing.
  6. Clarke, M. A., Steege, L. M., Moore, J. L., Belden, J. L., Koopman, R. J. & Kim, M. S. 2013. Addressing human computer interaction issues of electronic health record in clinical encounters. In: MARCUS, A. (ed.) Proceedings of the Second international conference on Design, User Experience, and Usability: health, learning, playing, cultural, and cross-cultural user experience - Volume Part II. Las Vegas, NV: SpringerVerlag.
  7. Cordes, R. E. 1993. The effects of running fewer subjects on time-on-task measures. International Journal of Human-Computer Interaction, 5, 393 - 403.
  8. Elliott, G. J., Jones, E. & Barker, P. 2002. A grounded theory approach to modelling learnability of hypermedia authoring tools. Interacting with Computers, 14, 547-574.
  9. Goldzweig, C. L., Towfigh, A., Maglione, M. & Shekelle, P. G. 2009. Costs and benefits of health information technology: New trends from the literature. Health Affairs, 28, w282-w293.
  10. Grabenbauer, L., Fraser, R., Mcclay, J., Woelfl, N., Thompson, C. B., Cambell, J. & Windle, J. 2011. Adoption of electronic health records: a qualitative study of academic and private physicians and health administrators. Appl Clin Inform, 2, 165-76.
  11. Hsiao, C.-J. & Hing, E. 2012. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2012. NCHS Data Brief, 1-8.
  12. Khajouei, R., Peek, N., Wierenga, P. C., Kersten, M. J. & Jaspers, M. W. 2010. Effect of predefined order sets and usability problems on efficiency of computerized medication ordering. Int J Med Inform, 79, 690-8.
  13. Kim, M. S., Shapiro, J. S., Genes, N., Aguilar, M. V., Mohrer, D., Baumlin, K. & Belden, J. L. 2012. A pilot study on usability analysis of emergency department information system by nurses. Applied Clinical Informatics, 3, 135-153.
  14. Koopman, R. J., Kochendorfer, K. M., Moore, J. L., Mehr, D. R., Wakefield, D. S., Yadamsuren, B., Coberly, J. S., Kruse, R. L., Wakefield, B. J. & Belden, J. L. 2011. A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care. Ann Fam Med, 9, 398-405.
  15. Kushniruk, A. W., Triola, M. M., Borycki, E. M., Stein, B. & Kannry, J. L. 2005. Technology induced error and usability: the relationship between usability problems and prescription errors when using a handheld application. Int J Med Inform, 74, 519-26.
  16. Lewis, Z. L., Douglas, G. P., Monaco, V. & Crowley, R. S. 2010. Touchscreen task efficiency and learnability in an electronic medical record at the point-of-care. Stud Health Technol Inform, 160, 101-5.
  17. Li, A. C., Kannry, J. L., Kushniruk, A., Chrimes, D., Mcginn, T. G., Edonyabo, D. & Mann, D. M. 2012. Integrating usability testing and think-aloud protocol analysis with "near-live" clinical simulations in evaluating clinical decision support. Int J Med Inform, 81, 761-72.
  18. Lin, H. X., Choong, Y.-Y. & Salvendy, G. 1997. A proposed index of usability: a method for comparing the relative usability of different software systems. Behaviour & Information Technology, 16, 267-277.
  19. Lorenzi, N. M., Kouroubali, A., Detmer, D. E. & Bloomrosen, M. 2009. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. Bmc Medical Informatics and Decision Making, 9.
  20. Love, J. S., Wright, A., Simon, S. R., Jenter, C. A., SORAN, C. S., Volk, L. A., Bates, D. W. & Poon, E. G. 2012. Are physicians' perceptions of healthcare quality and practice satisfaction affected by errors associated with electronic health record use? J Am Med Inform Assoc, 19, 610-4.
  21. Mclane, S. & Turley, J. P. 2012. One Size Does Not Fit All: EHR Clinical Summary Design Requirements for Nurses. Nurs Inform, 2012, 283.
  22. Menachemi, N. & Collum, T. H. 2011. Benefits and drawbacks of electronic health record systems. Risk Manag Healthc Policy, 4, 47-55.
  23. Miller, R. H., West, C., Brown, T. M., Sim, I. & Ganchoff, C. 2005. The Value Of Electronic Health Records In Solo Or Small Group Practices. Health Affairs, 24, 1127-1137.
  24. Nielsen, J. 1993. Usability engineering, Boston, Academic Press.
  25. Sauro, J. & Lewis, J. R. 2010. Average task times in usability tests: what to report? Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. Atlanta, Georgia, USA: ACM.
  26. Sheehan, B., Kaufman, D., Stetson, P. & Currie, L. M. 2009. Cognitive analysis of decision support for antibiotic prescribing at the point of ordering in a neonatal intensive care unit. AMIA Annu Symp Proc, 2009, 584-8.
  27. Shekelle, P. G., Morton, S. C. & Keeler, E. B. 2006. Costs and benefits of health information technology. Evid Rep Technol Assess (Full Rep), 1-71.
  28. Terry, A. L., Thorpe, C. F., Giles, G., Brown, J. B., Harris, S. B., Reid, G. J., Thind, A. & Stewart, M. 2008. Implementing electronic health records: Key factors in primary care. Can Fam Physician, 54, 730-6.
  29. Tullis, T. & Albert, W. 2008. Measuring the User Experience: Collecting, Analyzing, and Presenting Usability Metrics, Morgan Kaufmann Publishers Inc.
  30. Viitanen, J., Hypponen, H., Laaveri, T., Vanska, J., Reponen, J. & Winblad, I. 2011. National questionnaire study on clinical ICT systems proofs: physicians suffer from poor usability. Int J Med Inform, 80, 708-25.
  31. Walji, M. F., Kalenderian, E., Tran, D., Kookal, K. K., Nguyen, V., Tokede, O., White, J. M., Vaderhobli, R., Ramoni, R., Stark, P. C., Kimmes, N. S., SchoonheimKlein, M. E. & Patel, V. L. 2013. Detection and characterization of usability problems in structured data entry interfaces in dentistry. Int J Med Inform, 82, 128- 38.
  32. Whiteside, J., Jones, S., Levy, P. S. & Wixon, D. 1985. User performance with command, menu, and iconic interfaces. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. San Francisco, California, USA: ACM.
  33. Whittaker, A. A., Aufdenkamp, M. & Tinley, S. 2009. Barriers and facilitators to electronic documentation in a rural hospital. Journal of Nursing Scholarship, 41, 293-300.
  34. Yoon-Flannery, K., Zandieh, S. O., Kuperman, G. J., Langsam, D. J., Hyman, D. & kaushal, R. 2008. A qualitative analysis of an electronic health record (EHR) implementation in an academic ambulatory setting. Inform Prim Care, 16, 277-84.
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Paper Citation


in Harvard Style

Clarke M., Belden J. and Kim M. (2016). Comparing Electronic Health Record Usability of Primary Care Physicians by Clinical Year . In Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2016) ISBN 978-989-758-170-0, pages 68-75. DOI: 10.5220/0005692900680075


in Bibtex Style

@conference{healthinf16,
author={Martina A. Clarke and Jeffery L. Belden and Min Soon Kim},
title={Comparing Electronic Health Record Usability of Primary Care Physicians by Clinical Year},
booktitle={Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2016)},
year={2016},
pages={68-75},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0005692900680075},
isbn={978-989-758-170-0},
}


in EndNote Style

TY - CONF
JO - Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF, (BIOSTEC 2016)
TI - Comparing Electronic Health Record Usability of Primary Care Physicians by Clinical Year
SN - 978-989-758-170-0
AU - Clarke M.
AU - Belden J.
AU - Kim M.
PY - 2016
SP - 68
EP - 75
DO - 10.5220/0005692900680075