Human Factors for More Usable and Safer Health Information Technology: Where Are We Now and Where do We Go from Here?

Summary

A wide range of human factors approaches have been developed and adapted to healthcare for detecting and mitigating negative unexpected consequences associated with technology in healthcare (i.e. technology-induced errors). However, greater knowledge and wider dissemination of human factors methods is needed to ensure more usable and safer health information technology (IT) systems.

Objective: This paper reports on work done by the IMIA Human Factors Working Group and discusses some successful approaches that have been applied in using human factors to mitigate negative unintended consequences of health IT. The paper addresses challenges in bringing human factors approaches into mainstream health IT development.

Results: A framework for bringing human factors into the improvement of health IT is described that involves a multi-layered systematic approach to detecting technology-induced errors at all stages of a IT system development life cycle (SDLC). Such an approach has been shown to be needed and can lead to reduced risks associated with the release of health IT systems into live use with mitigation of risks of negative unintended consequences.

Conclusion: Negative unintended consequences of the introduction of IT into healthcare (i.e. potential for technology-induced errors) continue to be reported. It is concluded that methods and approaches from the human factors and usability engineering literatures need to be more widely applied, both in the vendor community and in local and regional hospital and healthcare settings. This will require greater efforts at dissemination and knowledge translation, as well as greater interaction between the academic and vendor communities.

 

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Keywords

Human factors - usability - electronic health records - safety - error - human-computer interaction - technology-induced error

 

 

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• References

• 1 Carayon P. Human factors and ergonomics in health care and patient safety.. In P. Carayon. editor. Handbook of human factors and ergonomics in health care and patient safety. Baca Raton, FL: CRC Press; 2012
• 2 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors.. J Am Med Inform Assoc 2004; 11: 104-12.
• 3 Borycki EM, Kushniruk AW, Bellwood P, Brender J. Technology-induced errors: The current use of frameworks and models from the biomedical and life sciences literatures.. Methods Inf Med 2012; 2: 95-103.
• 4 Borycki EM, Kushniruk AW. Where do technology-induced errors come from? Towards a model for conceptualizing and diagnosing errors caused by technology.. In: Kushniruk A, Borycki E. editors. Human, social, and organizational aspects of health information systems.. IGI Press; Hershey Penn: 2008
• 5 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE. et al. Role of computerized physician order entry systems in facilitating medication errors.. J Am Med Assoc 2005; Mar 9 293 (Suppl. 10) 1197-203.
• 6 Kushniruk AW, Triola MM, Borycki EM, Stein B, Kannry JL. Technology induced error and usability: the relationship between usability problems and prescription errors when using a handheld application.. Int J Med Inform 2005; 74 (Suppl. 07) 519-26.
• 7 Magrabi F, Ong MS, Runciman W, Coiera E. Using FDA reports to inform a classification for health information technology safety problems.. J Am Med Inform Assoc 2012; 19 (Suppl. 01) 45-53.
• 8 Kushniruk A, Nohr C, Jensen S, Borycki EM. From Usability Testing to Clinical Simulations: Bringing Context into the Design and Evaluation of Usable and Safe Health Information Technologies. Contribution of the IMIA Human Factors Engineering for Healthcare Informatics Working Group.. Yearb Med Inform 2012; 8 (Suppl. 01) 78-85.
• 9 Borycki E, Kushniruk A, Nohr C, Takeda H, Kuwata S, Carvalho C. et al. Usability Methods for Ensuring Health Information Technology Safety: Evidence-Based Approaches. Contribution of the IMIA Working Group Health Informatics for Patient Safety.. Yearb Med Inform 2012; 8 (Suppl. 01) 20-7.
• 10 Nielsen J. Usability engineering.. New York: Academic Press; 1993
• 11 Jensen S, Kushniruk A, Nøhr C. Clinical simulation: A method for development and evaluation of clinical information systems.. J Biomed Inform 2015; 54: 65-76.
• 12 Li AC, Kannry JL, Kushniruk A, Chrimes D, McGinn TG, Edonyabo D. et al. Integrating usability testing and think-aloud protocol analysis with “near-live” clinical simulations in evaluating clinical decision support.. Int J Med Inform 2012; Nov 30 81 (Suppl. 11) 761-72.
• 13 Beuscart-Zéphir MC, Pelayo S, Anceaux F, Meaux JJ, Degroisse M, Degoulet P. Impact of CPOE on doctor–nurse cooperation for the medication ordering and administration process.. Int J Med Inform 2005; Aug 31 74 (Suppl. 07) 629-41.
• 14 National Patient Safety Agency, National Reporting and Learning Service.. Design for patient safety: Guidelines for safety on-screen display of medication information.. United Kingdom, National Patient Safety Agency; 2010
• 15 Kushniruk A, Beuscart-Zéphir MC, Grzes A, Borycki E, Watbled L, Kannry J. Increasing the safety of healthcare information systems through improved procurement: toward a framework for selection of safe healthcare systems.. Healthc Q 2009; 13: 53-8.
• 16 Jensen S, Rasmussen SL, Lyng KM. Use of clinical simulation for assessment in EHR-procurement: design of method.. Stud Health Technol Inform 2013; 192: 576-80.
• 17 Russ AL, Fairbanks RJ, Karsh BT, Militello LG, Saleem JJ, Wears RL. The science of human factors: separating fact from fiction.. BMJ Qual Saf 2013; Nov 22 (Suppl. 11) 964-6.
• 18 Albert B, Tullis T, Tedesco D. Beyond the usability lab: Conducting large-scale online user experience studies.. Elsevier: New York; 2010
• 19 Kushniruk A, Kaipio J, Nieminen M, Hyppönen H, Lääveri T, Nohr C. et al. Human Factors in the Large: Experiences from Denmark, Finland and Canada in Moving Towards Regional and National Evaluations of Health Information System Usability: Contribution of the IMIA Human Factors Working Group.. Yearb Med Inform 2014; 9 (Suppl. 01) 67.
• 20 Kushniruk AW, Bates DW, Bainbridge M, Househ MS, Borycki EM. National efforts to improve health information system safety in Canada, the United States of America and England.. Int J Med Inform 2013; 82 (Suppl. 05) e149-60.
• 21 Nielsen J, Budiu R. Mobile usability.. Berkeley CA: New Riders; 2013
• 22 Bias RG, Mayhew DJ. editors. Cost-justifying usability: An update for the Internet age.. Elsevier; 2005 May 9.
• 23 Baylis TB, Kushniruk AW, Borycki EM. Low-cost rapid usability testing for health information systems: is it worth the effort?. Stud Health Technol Inform 2011; 180: 363-7.
• 24 Karat CM. Cost-benefit analysis of usability engineering techniques.. In: Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 1990; Oct 1 34 (Suppl. 12) 839-43.
• 25 Marcilly R, Beuscart-Zéphir MC, Ammenwerth E, Pelayo S. Seeking evidence to support usability principles for medication-related clinical decision support (CDS) functions.. In: MedInfo 2013 Aug 13. p. 427-31.
• 26 National Institute of Standards and Technology, Health IT Usability, Accessed (January 9, 2016) from: http://www.nist.gov/healthcare/usability.
• 27 Agency for Healthcare Research and Quality, EHR Usability Toolkit.. Accessed (January 9, 2016) from: https://healthit.ahrq.gov/sites/default/ files/docs/citation/EHR_Usability_Toolkit_Back-ground_Report.pdf.
• 28 Office of the National Coordinator.. Safer guides will help optimize safety.. 2014 https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/safer-guides-optimize-safety/.
• 29 Sittig DF, Ash JS, Singh H. ONC issues guides for SAFER EHRs.. J AHIMA 2014; 85 (Suppl. 04) 50-2.
• 30 Middleton B, Bloomrosen M, Dente MA, Hash-mat B, Koppel R, Overhage JM. et al. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.. J Am Med Inform Assoc 2013; 20 (Suppl. 01) e2-e8.
• 31 Chan J, Shojania KG, Easty AC, Etchells EE. Does user-centred design affect the efficiency, usability and safety of CPOE order sets?. J Am Med Inform Assoc 2011; 18 (Suppl. 03) 276-81.
• 32 Australian Commission on Safety and Quality in Health Care.. National Guidelines for On-Screen Display of Clinical Medicines Information.. Sydney, Commonwealth of Australia; 2016.