Romaric Marcilly

Usability Flaws in Medication Alerting Systems: Impact on Usage and Work System.

OBJECTIVES Previous research has shown that medication alerting systems face usability issues. There has been no previous attempt to systematically explore the consequences of usability flaws in such systems on users (i.e. usage problems) and work systems (i.e. negative outcomes). This paper aims at exploring and synthesizing the consequences of usability flaws in terms of usage problems and negative outcomes on the work system. METHODS A secondary analysis of 26 papers included in a prior systematic review of the usability flaws in medication alerting was performed. Usage problems and negative outcomes were extracted and sorted. Links between usability flaws, usage problems, and negative outcomes were also analyzed. RESULTS Poor usability generates a large variety of consequences. It impacts the user from a cognitive, behavioral, emotional, and attitudinal perspective. Ultimately, usability flaws have negative consequences on the workflow, the effectiveness of the technology, the medication management process, and, more importantly, patient safety. Only few complete pathways leading from usability flaws to negative outcomes were identified. CONCLUSION Usability flaws in medication alerting systems impede users, and ultimately their work system, and negatively impact patient safety. Therefore, the usability dimension may act as a hidden explanatory variable that could explain, at least partly, the (absence of) intended outcomes of new technology.

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.

Clinical evaluation of the ADE scorecards as a decision support tool for adverse drug event analysis and medication safety management.

The prevention of adverse drug events (ADEs) demands co‐ordination of different health care professionals. ADE scorecards are a novel approach to raise the team awareness regarding ADE risks and causes. It makes information on numbers and on possible causes of possible ADE cases available to the clinical team. The aim of the study was to investigate the usage and acceptance of ADE scorecards by healthcare professionals and their impact on rates of possible ADEs.

How to Present Evidence-Based Usability Design Principles Dedicated to Medication-Related Alerting Systems to Designers and Evaluators? Results from a Workshop.

Medication alerting system use errors and lack of adoption are often attributed to usability issues. Previous work has used evidence from the literature to reveal usability principles specific to medication alerting systems and identify potential consequences of violating these principles. The current study sought to explore how best to convey these principles to designers and evaluators of these systems to facilitate their work. To this aim, a workshop with 19 participants was used to generate ideas and opinions on how to deliver these topic-specific design principles in a way that would be most helpful for them. Participants generated ideas for how (e.g., a collaborative, continuously updated forum) and what (e.g., illustrations, checklists, evidence sources and strength, consequences of violations) information is most useful to disseminate usability principles for medication alerting systems. Participants, especially designers, expressed desire to use these principles in practice and avoid previously documented mistakes and therefore make design and evaluation of these systems more effective and efficient. Those insights are discussed in terms of feasibility and logistical challenges to developing the proposed documentation). To move this work forward, a more collaborative approach of Human Factors specialists in medical informatics is necessary.

Methodology to automatically detect abnormal values of vital parameters in anesthesia time-series

Abnormal values of vital parameters such as hypotension or tachycardia may occur during anesthesia and may be detected by analyzing time-series data collected during the procedure by the Anesthesia Information Management System. When crossed with other data from the Hospital Information System, abnormal values of vital parameters have been linked with postoperative morbidity and mortality. However, methods for the automatic detection of these events are poorly documented in the literature and differ between studies, making it difficult to reproduce results. In this paper, we propose a methodology for the automatic detection of abnormal values of vital parameters. This methodology uses an algorithm allowing the configuration of threshold values for any vital parameters as well as the management of missing data. Four examples illustrate the application of the algorithm, after which it is applied to three vital signs (heart rate, SpO2, and mean arterial pressure) to all 2014 anesthetic records at our institution.

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.

Citizens' Access to Their Digital Health Data in Eleven Countries - A Comparative Study

Governments around the world are actively promoting citizens electronic access to their health data as one of a number of ways to respond to the challenges of health care delivery in the 21st century. While numerous approaches have been utilized it is evident from cross-country comparisons that there are different conceptualizations of: both the expected and desired roles for citizens in the management of their own health; the benefits that will be delivered by citizen access and how these benefits should be measured and benchmarked over-time. This paper presents comparative analyses of the methods by which citizens are provided with access to their own health data across 11 countries. The paper aims to stimulate debate on electronic citizen access to health data and the challenges of measuring benefit as well as reflection on capacity of different citizens to engage with e-health.

Contribution of human factors in the design of a patient scheduling system for the pediatric emergency department

This paper presents how, in compliance with the standard ISO 9241-210:2010, Human Factors activities were implemented in the design of a patient scheduling system in order to decrease the overcrowding in a pediatric emergency department. More specifically, an original method to assess an algorithm with end-users is described. First, a work system analysis was performed through observations and interviews of physicians and nurses from the pediatric emergency department from a French 2965-bed academic hospital. Then, the work system was modeled with a focus on how the patients are arranged and on which criteria the arrangement is based. Those results allowed developing a patients arrangement algorithm along with recommendations to develop a patient scheduling system automatically fed by the existing electronic patient record system. A mock-up of the patient scheduling system has been developed in order to test upstream in the design process the proposed algorithm and a set of icons with healthcare professionals through user testing. Overall, results showed the end-users validated the patients arrangement algorithm and most of the icons. Next steps will be to develop and to implement the patient scheduling system in the pediatric emergency department in order to assess its impact.

Usability of production systems for discharge letters

At the end of an inpatient stay, the hospital physician produces a discharge letter intended for the General Practitioner in order to ensure the continuity of care between hospital and general practice. The French National Health Authority recommends (i) that the discharge letter should reach its addressee within 8 days and (ii) that it includes the information necessary to guarantee the quality of continued care. In order to achieve these goals, the discharge letter process is increasingly computerized. However, the usability of the technologies employed to produce the discharge letter may impair their impact; therefore it is important to evaluate the usability of those technologies to interpret their impact (or absence thereof) on performance and quality. This paper reports on the usability evaluation of two digital audio recorders. These technologies are different in terms of available features and material (wired connection vs. mobile). Three evaluation methods have been used: heuristic evaluation, user testing, and direct observation of usage in the hospital wards. Data are analyzed so as to identify usability flaws in the recorders and to highlight the consequences of these flaws on the user and on the work system. Our results show that the most important consequences are an increase in the production duration of a letter and in the risk of patient misidentification.