Sylvia Pelayo

A comparative review of patient safety initiatives for national health information technology

OBJECTIVE To collect and critically review patient safety initiatives for health information technology (HIT). METHOD Publicly promulgated set of advisories, recommendations, guidelines, or standards potentially addressing safe system design, build, implementation or use were identified by searching the websites of regional and national agencies and programmes in a non-exhaustive set of exemplar countries including England, Denmark, the Netherlands, the USA, Canada and Australia. Initiatives were categorised by type and software systems covered. RESULTS We found 27 patient safety initiatives for HIT predominantly dealing with software systems for health professionals. Three initiatives addressed consumer systems. Seven of the initiatives specifically dealt with software for diagnosis and treatment, which are regulated as medical devices in England, Denmark and Canada. Four initiatives dealt with blood bank and image management software which is regulated in the USA. Of the 16 initiatives directed at unregulated software, 11 were aimed at increasing standardisation using guidelines and standards for safe system design, build, implementation and use. Three initiatives for unregulated software were aimed at certification in the USA, Canada and Australia. Safety is addressed alongside interoperability in the Australian certification programme but it is not explicitly addressed in the US and Canadian programmes, though conformance with specific functionality, interoperability, security and privacy requirements may lead to safer systems. England appears to have the most comprehensive safety management programme for unregulated software, incorporating safety assurance at a local healthcare organisation level based on standards for risk management and user interface design, with national incident monitoring and a response function. CONCLUSIONS There are significant gaps in the safety initiatives for HIT systems. Current initiatives are largely focussed on software. With the exception of diagnostic, prognostic, monitoring and treatment software, which are subject to medical device regulations in some countries, the safety of the most common types of HIT systems such as EHRs and CPOE without decision support is not being explicitly addressed in most nations. Appropriate mechanisms for safety assurance are required for the full range of HIT systems for health professionals and consumers including all software and hardware throughout the system lifecycle. In addition to greater standardisation and oversight to ensure safe system design and build, appropriate implementation and use of HIT is critical to ensure patient safety.

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.

Facteurs humains et ergonomie en informatique médicale

Apres avoir lu ce chapitre, vous devriez : avoir compris ce que sont les facteurs humains et l’ergonomie, et leurs relations avec l’informatique medicale ; connaitre les principes de la demarche ergonomique et des facteurs humains dans la conception de systemes homme-machine en sante ; connaitre les principes de l’analyse des situations de travail ; savoir ce qu’est une conception centree utilisateur et decrire la demarche d’evaluation de l’utilisabilite de systemes informatiques ; avoir compris la notion de systeme socio-technique complexe.

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.

Comparative evaluation of two applications for delivering a multimedia medical course in the French-speaking Virtual Medical University (UMVF).

This paper describes a comparative evaluation of two applications delivering a multimedia course: a conventional web server (WS) and an integrated e-learning platform in the form of a virtual campus (VC). We used a qualitative method for comparing their acceptance of the on-line course provided by the two different interfaces. The two groups were globally satisfied. However, a decrease in satisfaction was noted at the end of the experimentation in the VC group. This may be explained by a more complex graphic user interface of the VC and some constraints which do not exist with the WS. Students from both groups also had limitations about the multimedia environment.

Findings from the 2018 Yearbook Section on Human Factors and Organizational Issues

Summary Objective:  To summarize significant research contributions published in 2017 on Human Factors and Organizational Issues (HFOI) in medical informatics. Methods:  An extensive search using PubMed/Medline and Web of Science ® was conducted to identify the scientific contributions published in 2017 that HFOI issues in medical informatics. The selection process comprised three steps: (i) 15 candidate best papers out of 695 references were first selected by the two section editors, (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper, and (iii) the final selection of five best papers was conducted by the editorial board of the Yearbook. Results:  The five best papers offer a glimpse of the quality and breadth of the work being conducted in the HFOI community. Conclusion:  The selection of the HFOI section of the 2018 IMIA Yearbook highlights a growing number of high quality studies. There are especially more studies interested in testing Human Factors and Ergonomics methods and demonstrating the benefits.