Ancker JS, Edwards A, Nosal S, Hauser D, Mauer E, Kaushal R, with the HITEC Investigators
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical
decision support system
BMC Med Inform Decis Mak 2017 Apr 10;17(1):36
Although alert fatigue is blamed for high override rates in contemporary clinical
decision support systems, the concept of alert fatigue is poorly defined. This study
tests two possible alert fatigue mechanisms: (i) cognitive overload associated with a high amount of work, complexity of work, and efforts distinguishing
informative from uninformative alerts, and (ii) desensitization from repeated exposure to the same alert over time. The results show that clinicians
became less likely to accept alerts as they received a lot of them, particularly in
the case of repeated alerts. There was no evidence of an effect of workload per se,
or of desensitization over time for a newly deployed alert.
Blijleven V, Koelemeijer K, Wetzels M, Jaspers M
Workarounds emerging from electronic health record system usage: consequences for
patient safety, effectiveness of care, and efficiency of care
JMIR Hum Factors 2017 Oct 5;4(4):e27
Health care providers resort to informal temporary practices known as workarounds
for handling exceptions to normal workflow unintendedly imposed by electronic health
record systems (EHRs). Research on the scope and impact of EHR workarounds on patent
care processes is scarce. Based on a large case study, the authors present an overview
of 15 bottom-up identified rationales for EHR workarounds and give a definition for
each rationale. In addition, for the most prominent workarounds, their scope and impact
on patient safety, effectiveness of care, and efficiency of care are discussed from
a sociotechnical perspective using the Systems Engineering Initiative for Patient
Safety (SEIPS) framework.
Cresswell KM, Mozaffar H, Lee L, Williams R, Sheikh A
Safety risks associated with the lack of integration and interfacing of hospital health
information technologies: a qualitative study of hospital electronic prescribing systems
in England
BMJ Qual Saf 2017 Jul;26(7):530-41
Mitigating safety risks in health information technology is highly dependent on the
effective integration of information within systems and/or interoperability to allow
information exchange across systems. The paper explores the social and technical challenges
relating to integration and interfacing experienced by early adopter hospitals of
standalone and hospital-wide multi-modular integrated electronic prescribing systems.
Based on a longitudinal qualitative study, the results highlight that while multi-modular
systems offer somewhat better usability, standalone systems provide greater flexibility
and opportunity for innovation, particularly in relation to interoperability with
external systems and to customizability to the needs of different user groups.
Dufendach KR, Koch S, Unertl KM, Lehmann CU
A randomized trial comparing classical participatory design to VandAID, an interactive
crowdsourcing platform to facilitate user-centered design
Methods Inf Med 2017 Oct 26;56(5):344-9
Early involvement of stakeholders in the design of medical software is particularly
important due to the need to incorporate complex knowledge and actions associated
with clinical work. Standard user-centered design (UCD) methods may limit user involvement
to a small number of individuals due to the significant time investment from designers
and end users. VandAID, a new web-based crowdsourcing platform, was tested in a randomized
trial. The results show that VandAID can simultaneously involve multiple users in
UCD and provides means of obtaining design feedback remotely.
Luna DR, Rizzato Lede DA, Otero CM, Risk MR, González Bernaldo de Quirós F
User-centered design improves the usability of drug-drug interaction alerts: experimental
comparison of interfaces
J Biomed Inform 2017 Feb;66:204-13
Clinical Decision Support Systems can alert health professionals about drug-drug interactions
when they prescribe medications. But the alert override rate of this kind of system
is very high. This paper describes the methodology of a User-Centered Design (UCD)
that goes beyond UCD and cooperative design approaches to include end users as active
participants in the design and decision-making. The authors tested a crossover method
for scientifically compare the usability of an interface designed with standard method
with an interface designed with a participatory UCD in terms of efficiency, effectiveness,
and user satisfaction.
