Marie-Catherine Beuscart-Zéphir

Example of a Human Factors Engineering approach to a medication administration work system: Potential impact on patient safety

OBJECTIVE The objectives of this paper are: In this approach, the implementation of such a complex IT solution is considered a major redesign of the work system. The paper describes the Human Factor (HF) tasks embedded in the project lifecycle: (1) analysis and modelling of the current work system and usability assessment of the medication CPOE solution; (2) HF recommendations for work re-design and usability recommendations for IT system re-engineering both aiming at a safer and more efficient work situation. METHODS Standard ethnographic methods were used to support the analysis of the current work system and work situations, coupled with cognitive task analysis methods and documents review. Usability inspection (heuristic evaluation) and both in-lab (simulated tasks) and on-site (real tasks) usability tests were performed for the evaluation of the CPOE candidate. Adapted software engineering models were used in combination with usual textual descriptions, tasks models and mock-ups to support the recommendations for work and product re-design. RESULTS The analysis of the work situations identified different work organisations and procedures across the hospitals departments. The most important differences concerned the doctor-nurse communications and cooperation modes and the procedures for preparing and administering the medications. The assessment of the medication CPOE functions uncovered a number of usability problems including severe ones leading to impossible to detect or to catch errors. Models of the actual and possible distribution of tasks and roles were used to support decision making in the work design process. The results of the usability assessment were translated into requirements to support the necessary re-engineering of the IT application. CONCLUSION The HFE approach to medication CPOE efficiently identifies and distinguishes currently unsafe or uncomfortable work situations that could obviously benefit from an IT solution from other work situations incorporating efficient work procedures that might be impaired by the implementation of the CPOE. In this context, a careful redesign of the work situation and of the entire work system is necessary to actually benefit from the installation of the product in terms of patient safety and human performances. In parallel, a usability assessment of the product to be implemented is mandatory to identify potentially dangerous usability flaws and to fix them before the installation.

Integrating the SE and HCI models in the human factors engineering cycle for re-engineering Computerized Physician Order Entry systems for medications: Basic principles illustrated by a case study

OBJECTIVES The integration of Human Factors is still insufficient in the design and implementation phases of complex interactive systems such as Computerized Physician Order Entry (CPOE) systems. One of the problems is that human factors specialists have difficulties to communicate their data and to have them properly understood by the computer scientists in the design and implementation phases. This paper presents a solution to this problem based on the creation of common documentation supports using Software Engineering (SE) and Human-Computer Interaction (HCI) methods. METHOD The integration of SE and HCI methods and models is an interesting means for modelling an organizations activities, with software applications being part of these activities. Integrating these SE and HCI methods and models allows case studies to be seen from the technical, organizational and ergonomic perspectives, and also makes it easier to compare current and future work situations. RESULTS The exploitation of these techniques allows the creation of common work supports that can be easily understandable by computer scientists and relevant for re-engineering or design. In this paper, the basic principles behind such communication supports are described and illustrated by a real case study.

Usability flaws of medication-related alerting functions

INTRODUCTION Medication-related alerting functions may include usability flaws that limit their optimal use. A first step on the way to preventing usability flaws is to understand the characteristics of these usability flaws. This systematic qualitative review aims to analyze the type of usability flaws found in medication-related alerting functions. METHOD Papers were searched via PubMed, Scopus and Ergonomics Abstracts databases, along with references lists. Paper selection, data extraction and data analysis was performed by two to three Human Factors experts. Meaningful semantic units representing instances of usability flaws were the main data extracted. They were analyzed through qualitative methods: categorization following general usability heuristics and through an inductive process for the flaws specific to medication-related alerting functions. MAIN RESULTS From the 6380 papers initially identified, 26 met all eligibility criteria. The analysis of the papers identified a total of 168 instances of usability flaws that could be classified into 13 categories of usability flaws representing either violations of general usability principles (i.e. they could be found in any system, e.g. guidance and workload issues) or infractions specific to medication-related alerting functions. The latter refer to issues of low signal-to-noise ratio, incomplete content of alerts, transparency, presentation mode and timing, missing alert features, tasks and control distribution. MAIN CONCLUSION The list of 168 instances of usability flaws of medication-related alerting functions provides a source of knowledge for checking the usability of medication-related alerting functions during their design and evaluation process and ultimately constructs evidence-based usability design principles for these functions.

Context Sensitive Health Informatics: Concepts, Methods and Tools

Context is a key consideration when designing and evaluating health information technology (HIT) and cannot be overstated. Unintended consequences are common post HIT implementation and even well designed technology may not achieve desired outcomes because of contextual issues. While context should be considered in the design and evaluation of health information systems (HISs) there is a shortcoming of empirical research on contextual aspects of HIT. This conference integrates the sociotechnical and Human-Centered-Design (HCD) approaches and showcases current research on context sensitive health informatics. The papers and presentations outlines theories and models for studying contextual issues and insights on how we can better design HIT to accommodate different healthcare contexts.

Improving access to clinical practice guidelines with an interactive graphical interface using an iconic language

BackgroundClinical practice guidelines are useful for physicians, and guidelines are available on the Internet from various websites such as Vidal Recos. However, these guidelines are long and difficult to read, especially during consultation. Similar difficulties have been encountered with drug summaries of product characteristics. In a previous work, we have proposed an iconic language (called VCM, for Visualization of Concepts in Medicine) for representing patient conditions, treatments and laboratory tests, and we have used these icons to design a user interface that graphically indexes summaries of product characteristics. In the current study, our objective was to design and evaluate an iconic user interface for the consultation of clinical practice guidelines by physicians.MethodsFocus groups of physicians were set up to identify the difficulties encountered when reading guidelines. Icons were integrated into Vidal Recos, taking human factors into account. The resulting interface includes a graphical summary and an iconic indexation of the guideline. The new interface was evaluated. We compared the response times and the number of errors recorded when physicians answered questions about two clinical scenarios using the interactive iconic interface or a textual interface. Users’ perceived usability was evaluated with the System Usability Scale.ResultsThe main difficulties encountered by physicians when reading guidelines were obtaining an overview and finding recommendations for patients corresponding to “particular cases”. We designed a graphical interface for guideline consultation, using icons to identify particular cases and providing a graphical summary of the icons organized by anatomy and etiology. The evaluation showed that physicians gave clinical responses more rapidly with the iconic interface than the textual interface (25.2 seconds versus 45.6, p < 0.05). The physicians appreciated the new interface, and the System Usability Scale score value was 75 (between good and excellent).ConclusionAn interactive iconic interface can provide physicians with an overview of clinical practice guidelines, and can decrease the time required to access the content of such guidelines.

The usability-error ontology.

Clinical Systems have become standard partners with clinicians in the care of patients. As these systems become integral parts of the clinical workflow, they have the potential to help improve patient outcomes, however they have also in some cases have led to adverse events and has resulted in patients coming to harm. Often the root cause analysis of these adverse events can be traced back to Usability Errors in the Health Information Technology (HIT) or its interaction with users. Interoperability of the documentation of HIT related Usability Errors in a consistent fashion can improve our ability to do systematic reviews and meta-analyses. In an effort to support improved and more interoperable data capture regarding Usability Errors, we have created the Usability Error Ontology (UEO) as a classification method for representing knowledge regarding Usability Errors. We expect the UEO will grow over time to support an increasing number of HIT system types. In this manuscript, we present this Ontology of Usability Error Types and specifically address Computerized Physician Order Entry (CPOE), Electronic Health Records (EHR) and Revenue Cycle HIT systems.

Next steps in evaluation and evidence: from generic to context-related

INTRODUCTION E-health systems are increasingly important and widespread, but their selection and implementation are still frequently based on belief, rather than scientific evidence, and adverse effects are not systematically addressed. Progress is being made in promoting generic evaluation methodologies as a source of scientific evidence, but effort is now needed to consider methods for special situations. METHOD Review of five evaluation contexts - national e-health plans, telemedicine, Health Informatics 3.0, usability and economics. CONCLUSION Identification of requirements for approaches to be developed in these five settings.

First experimentation of the ErgoPNets method using dynamic modeling to communicate usability evaluation results

When a computer application is being designed or re-engineered, especially a user-centred application, communication between ergonomists and computer scientists is very important. However, the formalisms used to describe ergonomic problems and recommendations are often based on natural language. Consequently, the results of ergonomic evaluation can be poorly understood or interpreted by computer scientists. To remedy this problem, we propose a method, called ErgoPNets. The method creates common work support for both the ergonomists and the computer scientists working on the same project. Comprehensible for everyone, this support must provide an efficient tool that can be used by each person involved. ErgoPNets uses Petri nets to model Human-Computer Interaction (HCI) procedures and ergonomic criteria to model the ergonomic analysis. A first experimentation has been performed with designers/developers and academic researchers.

Towards an assistance for selecting methods and models for interactive software design or re-engineering within complex organisation: Application case of a CPOE software

The hospital activities display all of the characteristics of a very complex sociotechnic organisation. Consequently, the design of Computerized Physician Order Entry (CPOE) softwares which support this type of activity is very difficult. The Study of the procedure of these projects shows communication information problems between project partners. This article proposes the principles of an approach, based on Software Engineering (SE) and Human-Computer Interaction (HCI) methods and models, allowing improving the transmission of information during design or re-engineering projects within complex organisation.

Evidence-based usability design principles for medication alerting systems

BackgroundUsability flaws in medication alerting systems may have a negative impact on clinical use and patient safety. In order to prevent the release of alerting systems that contain such flaws, it is necessary to provide designers and evaluators with evidence-based usability design principles. The objective of the present study was to develop a comprehensive, structured list of evidence-based usability design principles for medication alerting systems.MethodsNine sets of design principles for medication alerting systems were analyzed, summarized, and structured. We then matched the summarized principles with a list of usability flaws in order to determine the level of underlying evidence.ResultsFifty-eight principles were summarized from the literature and two additional principles were defined, so that each flaw was matched with a principle. We organized the 60 summarized usability design principles into 6 meta-principles, 38 principles, and 16 sub-principles. Only 15 principles were not matched with a usability flaw. The 6 meta-principles respectively covered the improvement of the signal-to-noise ratio, the support for collaborative working, the fit with a clinician’s workflow, the data display, the transparency of the alerting system, and the actionable tools to be provided within an alert.ConclusionsIt is possible to develop an evidence-based, structured, comprehensive list of usability design principles that are specific to medication alerting systems and are illustrated by the corresponding usability flaws. This list represents an improvement over the current literature. Each principle is now associated with the best available evidence of its violation. This knowledge may help to improve the usability of medication alerting systems and, ultimately, decrease the harmful consequences of the systems’ usability flaws.