The vision of this study is to increase Computerized Physician Order Entry (CPOE) acceptance and usage by reducing usability issues through an improved method of usability testing and error reporting. The goal of this study is to define a new, faster, less expensive usability evaluation method (UEM) intended for healthcare providers which facilitates their input during the Participatory Design (PD) process. This UEM defines a set of non-technical guidelines for the healthcare provider to assess, identify and report to technologists usability errors within a CPOE system. This study defines this UEM in the context of usability testing of the order placement and verification components within a Computerized Provider Medication Order Entry (CPMOE), e-prescription or e-Rx system.
Due to limited literature specific to usability issues in CPMOE, the methodology to develop these guidelines included a broad literature review of Unintended Adverse Consequences (UAC) found both within Patient Care Information Systems (PCIS) as well as other electronic systems, such as the airline and nuclear energy. Those UAC that violated any of the characteristics of the ISO definition of usability were considered usability issues and selected for this study.
Next, a series of personal informal interviews were conducted with providers who use CPMOE as part of their daily work routine. These interviews helped to describe characteristics of CPMOE systems where these usability issues arise.
Each selected usability issue was placed into one of five grouping based on how that issue negatively impacted the medication ordering process. Characteristics of the CPMOE systems containing each group of usability issues were then defined.
Five hypotheses were defined each proposing a set of guidelines for a clinician to consider when evaluating a CPMOE system for the characteristics of each group of usability issue. These hypotheses were intended to identify the following groups of usability issues: Workflow-Related Usability, Design and Navigation-Related Usability, User Input-Related Usability, User Feedback and Response-Related Usability, Alert Fatigue-related Usability.
Each hypothesis was then tested by integrating their guidelines into a scenario test plan. The test plans were executed by clinicians while evaluating the usability of the CPMOE component of an Electronic Health Record (EHR).
The results of the scenario testing identified 45 usability issues along with suggestions for their resolution.
The most significant findings for each test included the following: 1. Workflow related usability testing identified a disruption to the medication ordering workflow by requiring the clinician to complete an allergy review despite the clinician already having updated patient's allergies. Once the allergy list is updated, the CPMOE should not require the clinician to review the allergies again prior to completing their order. 2. Navigation related usability testing identified inconsistent methods of selecting modalities on the order placement screen; some required mouse-clicks, some allowed selection by the tab key. Moving hands between the keyboard and mouse impacts efficiency therefore all items in CPMOE should allow for selection with the tab key. 3. User input related usability testing identified the failure of partial name searches to identify medications, pharmacies and diagnosis. The clinician was required to search by the full name to locate item they were searching for. 4. Feedback and response usability testing identified issues with the Associate Diagnosis window which required multiple steps but provided no instructions on completing the task. 5. Alert Fatigue related usability identified dosage alarms which repeatedly displayed when the clinician accepted the default values for a medication's dosage.
All five hypotheses succeeded in identifying usability issues within a CPMOE; therefore the goal of this study is considered to have been achieved.
This study did not include an evaluation of the health care provider's proposal for a solution to eliminate the usability issue. Further analysis is required before these solutions can be considered practical or effective to ensure a more usable CPMOE system. This study could be expanded to further evaluate each proposed solution as many may be impractical or result in other UAC.
The testing of the five hypotheses was very short using only six testers. Software testing is iterative in nature and typically spans several months. This study did not address the nature or complexity of the usability issues identified. Therefore many complex usability issues may be missed with this UEM.
The clinical participants did not necessarily work in the specific field defined for the scenario they were testing. In one scenario, a family practice physician played the role of an OB-GYN. Despite the assurance that the participants understood each workflow, it is likely they did not have detailed knowledge of the role they played during testing. This study may be improved by including participants who work in the specific field defined in the test scenario. (Abstract shortened by UMI.)
|Commitee:||Greene, James E., Jimenez, Ronald W., Odor, Alberto|
|School:||University of California, Davis|
|Department:||Health Informatics (formerly Medical Informatics)|
|School Location:||United States -- California|
|Source:||MAI 53/06M(E), Masters Abstracts International|
|Subjects:||Information Technology, Information science, Health care management|
|Keywords:||Computerized physician order entry, Medical software, Usability testing|
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