Maryam Zahabi

Usability and Safety in Electronic Medical Records Interface Design: A Review of Recent Literature and Guideline Formulation

Objective The objectives of this study were to (a) review electronic medical record (EMR) and related electronic health record (EHR) interface usability issues, (b) review how EMRs have been evaluated with safety analysis techniques along with any hazard recognition, and (c) formulate design guidelines and a concept for enhanced EMR interfaces with a focus on diagnosis and documentation processes. Background A major impact of information technology in health care has been the introduction of EMRs. Although numerous studies indicate use of EMRs to increase health care quality, there remain concerns with usability issues and safety. Method A literature search was conducted using Compendex, PubMed, CINAHL, and Web of Science databases to find EMR research published since 2000. Inclusion criteria included relevant English-language papers with subsets of keywords and any studies (manually) identified with a focus on EMR usability. Results Fifty studies met the inclusion criteria. Results revealed EMR and EHR usability problems to include violations of natural dialog, control consistency, effective use of language, effective information presentation, and customization principles as well as a lack of error prevention, minimization of cognitive load, and feedback. Studies focusing on EMR system safety made no objective assessments and applied only inductive reasoning methods for hazard recognition. Conclusion On the basis of the identified usability problems and structure of safety analysis techniques, we provide EMR design guidelines and a design concept focused on the diagnosis process and documentation. Application The design guidelines and new interface concept can be used for prototyping and testing enhanced EMRs.

The role of driver age in performance and attention allocation effects of roadway sign count, format and familiarity

White-on-blue logo signs are used to inform drivers of food, gas, lodging, and attraction businesses at highway interchanges. In this study, 60 drivers were asked to look for food and attraction targets on logo signs while driving in a realistic freeway simulation. The objective of the study was to quantify effects of the number of sign panels (six vs. nine), logo familiarity (familiar vs. unfamiliar), logo format (text vs. pictorial), and driver age (young, middle, and elderly) on performance, attention allocation and target identification accuracy. Results revealed elderly drivers to exhibit worse performance in comparison to middle-age and young groups even though they adopted a more conservative driving strategy. There was no significant effect of the number of panels, logo familiarity, and logo format on driver performance or attention allocation. In target identification, drivers were more accurate with familiar or text-based panels appearing in six-panel signs.

The effects of interruption similarity and complexity on performance in a simulated visual-manual assembly operation

The objective of the study was to assess the effects of interruption task similarity and complexity on performance of a simulated industrial assembly operation. Eighteen participants performed a simulated industrial assembly operation, including one trial with no interruption and eight others presenting an interruption task. Interruption conditions comprised a full crossing of task similarity to the primary assembly operation (similar, dissimilar) and complexity (simple, complex) with replication for each participant. Order of condition presentation was randomized. Findings revealed greater time to return to primary visual-manual assembly performance after a similar task interruption. Results also indicated complex interruptions may promote cognitive arousal that increases productivity following assembly interruptions. The majority of results are explained in terms of the Activation-Based Memory for Goals model. Findings provide some guidance for interruption management protocol design for workers engaged in procedural visual-manual assembly operations.

The Effect of Physical Workload and Modality of Information Presentation on Cognitive Inhibition in Highly Fit Young Males

OCCUPATIONAL APPLICATIONS This study presents an experiment assessing the interaction between physical task load and modality of information presentation on cognitive task performance. Results indicated that males of equivalent high fitness, between the ages of 18 and 25, can perform complex cognitive tasks reliably well while performing a concurrent physical task requiring up to 70% of aerobic capacity. Furthermore, results revealed that participants respond slightly more quickly to visual stimuli than auditory stimuli but are equally adept at inhibiting responses presented via either modality. These results are applicable to the design of information displays for information processing tasks as part of occupations requiring simultaneous worker physical performance, such as soldiers in combat situations, firefighters in emergency rescue, police officers in security patrols on foot, etc.TECHNICAL ABSTRACT Background: Many occupations require workers to perform cognitive tasks while concurrently performing a physical task, such as a soldier taking orders while running to a helicopter evacuation point or a firefighter navigating through a burning building. Diverse personal factors have been identified to influence the effect of physical workload on cognitive performance; however, the literature presents some contradictions, and findings appear heavily dependent on participant sample characteristics, physical task type, and cognitive task type. Purpose: The purpose of this study was to assess the interaction between physical workload and modality of information presentation on performance of a concurrent cognitive task by highly fit young males. Methods: Twenty-four highly fit males between the ages of 18 and 25 completed the experiment. Participants ran on a treadmill at one of three physical exertion levels (0%, 50%, and 70% of maximal oxygen uptake [VO2max]). Levels were selected based on a previously-defined “optimal range” of 40%–55% VO2max for facilitating concurrent cognitive performance. Participants were exposed to exertion below, within, or above the optimal range for 8 minutes in each trial while concurrently performing a stop-signal task with stimuli presented either visually or aurally. Accuracy, response time, stop-signal reaction time, and perceived cognitive workload were recorded. Results: Physical exertion level did not appear to have a significant effect on responses with the exception of a decrease in accuracy that approached significance (p < 0.10). Stimulus modality had a significant effect, with higher accuracy, lower response time, and lower stop-signal reaction time occurring with visual stimuli compared to auditory. The modality of the stop signal (an indicator that participants should inhibit a reaction) had no effect on any response. No significant interaction was found between physical exertion level and modality of information presentation on cognitive inhibition. Conclusions: Highly fit young males, when subjected to an acute bout of exercise requiring 70% VO2max or less and lasting 8 minutes or less, exhibit no negative effects on cognitive inhibition performance, but response time appears faster with visual versus auditory stimuli.

Effect of police mobile computer terminal interface design on officer driving distraction

Several crash reports have identified in-vehicle distraction to be a primary cause of emergency vehicle crashes especially in law enforcement. Furthermore, studies have found that mobile computer terminals (MCTs) are the most frequently used in-vehicle technology for police officers. Twenty police officers participated in a driving simulator-based assessment of visual behavior, performance, workload and situation awareness with current and enhanced MCT interface designs. In general, results revealed MCT use while driving to decrease officer visual attention to the roadway, but usability improvements can reduce the level of visual distraction and secondary-task completion time. Results also suggest that use of MCTs while driving significantly reduces perceived level of driving environment awareness for police officers and increases cognitive workload. These findings may be useful for MCT manufacturers in improving interface designs to increase police officer and civilian safety.

Enhanced Hazard Analysis and Risk Assessment for Human-in-the-Loop Systems

Objective: The objective of this study was to enhance the existing system hazard analysis (SHA) technique by introducing the concepts of human and automation reliability quantification as well as fuzzy classification of system risks. These enhancements led to formulation of a new overall system risk-reliability score. Background: Many system safety analysis methods focus on individual physical component failure. Some human reliability analyses (HRA) consider human-automation interaction in determining system failure rates. There is no system safety analysis technique that quantifies the impact of human and automation reliability on the risk of hazard exposure. Method: Classification of the probability and severity of hazard exposure is typically made in terms of linguistic rather than numerical variables. Fuzzy sets are applicable for transforming linguistic classifications to numerical quantities. We focused on using fuzzy sets to define overlapping bands of system risk exposure with reference to the hazard risk categories defined in MIL-STD 882B. Fuzzy sets were also used for human-automated system reliability classification. Results: Introduction of human and automation reliability assessment in the SHA allows for definition of a system risk-reliability modeling space. The enhanced SHA (E-SHA) technique yields a mishap risk index, which is projected based on a composite assessment of human-automated system reliability at the time of operation. The E-SHA was compared with one of the most advanced HRA techniques. Conclusion: The E-SHA technique supports broader safety control recommendations and provides comparable, if not more detailed, results than prior systems safety and HRA techniques.

Driver performance and attention allocation in use of logo signs on freeway exit ramps

The objective of this research was to quantify the effects of driver age, ramp signage configuration, including number of panels, logo format and sign familiarity, on driver performance and attention allocation when exiting freeways. Sixty drivers participated in a simulator study and analysis of variance models were used to assess response effects of the controlled manipulations. Results revealed elderly drivers to demonstrate worse performance and conservative control strategies as compared to middle-aged and young drivers. Elderly drivers also exhibited lower off-road fixation frequency and shorter off-road glance durations compared to middle-aged and young drivers. In general, drivers adopted a more conservative strategy when exposed to nine-panel signs as compared to six-panel signs and were more accurate in target detection when searching six-panels vs. nine and with familiar vs. unfamiliar logos. These findings provide an applicable guide for agency design of freeway ramp signage accounting for driver demographics.

Effect of Driver Age and Distance Guide Sign Format on Driver Attention Allocation and Performance

Although several studies have assessed the effect of business logo sign format on driver visual attention and performance, some concern has been expressed that findings may not be generalizable to other signage configurations. We conducted a driving simulation study to assess the effect of distance guide sign format on visual attention allocation, target detection accuracy, and driving performance considering driver demographics. Results revealed distance guide sign format, including random or distance-ordered presentation of destinations, to have no impact on driver visual attention, target identification, and vehicle control. However, elderly drivers had difficulty in identifying targets when destinations were presented in random order. In addition, elderly drivers exhibited conservative responses (i.e., reduced off-road visual attention and greater speed reductions) as compared to other age groups when exposed to distance guide signs. Findings support design guidance for on-road signage to account for driver demographics.

Driver Accuracy in Identifying Food and Attraction Targets on Business Logo Signs: Impacts of Driver Age, Number of Panels, Logo Familiarity, and Logo Format

The standard business logo sign found along North Carolina highways contains six logos, in accordance with the Manual on Uniform Traffic Control Devices. As the population grows, the demand for business is increasing. Shifting from six-panel business logo signs to nine-panel signs would afford more businesses the opportunity to advertise in areas of high demand. The effects that such a change may have on the driving population are analyzed. Factors such as a driver’s age and familiarity with logos and logo format are taken into consideration. A change in the format of business logo signs is proposed not only to move from six to nine panels but also to improve the effectiveness of existing business logo signs.

On-Road Visual Sign Salience, Driver Attention Allocation, and Target Detection Accuracy

Previous studies have empirically assessed the effect of on-road signage on driver distraction and attention allocation through eye-tracking measures and driving simulations. However, state and federal agencies might be able to make use of simpler approaches to determining the potential visual load of on-road signs. This study compared different on-road signage (food, gas and attraction, and distance guide signs) with respect to visual salience, assessed the effect of the number of panels and logo format on signage salience, and analyzed associations between salience values for different sign types with target detection accuracy and off-road glance duration. Visual salience of signs was measured with the salience using the natural statistics (SUNs) method. For correlation analyses between sign salience, attention allocation, and detection accuracy, a sample of 120 drivers participated in two driving simulation studies. Results revealed food business signs, containing all pictorial logos, to be more salient than gas and attraction and distance guide signs. In addition, results revealed that increasing the number of sign panels from six to nine significantly increased visual salience. It was also found that attraction signs including all pictorial logos were more salient than signs with text-based logos. Results did not reveal statistically significant relationships between visual salience and attention allocation. In addition, there was no significant correlation between target detection accuracy and visual salience for various sign types. Future work with a higher sign-sampling rate is needed to assess whether the SUNs method is a useful measure for determining if roadway sign salience is a driving factor in distraction.