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Group 3 Methods Submitted

This Document outlines the methodology section submitted by Group 3, detailing their research approach, tools used, and data collection strategies for their academic project.

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    Usability and Information design for Electronic Health Record Systems: Improving EHR usability with the help of Information Systems This project will focus on the health information technology (HIT) intervention for the improvement of Electronic Health Record (EHR) usability. Overview The Healthcare Information and Management Systems Society (HIMSS) defined usability as the effectiveness, efficiency and satisfaction with which specific users can achieve a specific set of tasks in a particular environment (himss.org, 2019). From this statement, clinicians, physicians and end-users of EHR needs to be efficient and effective using EHR. Efficiency is the speed at which users can complete the tasks while effectiveness is the accuracy and completeness of the tasks at hand. While keeping these two terms in mind, the goals of this project is using HIT intervention to assess and improve EHR usability among its users thereby providing a meaningful use of the systems. As described by pewtrust.org, poor usability of EHR can lead to many errors, unforeseen safety risks, and other serious mistakes, which may lead to unintended consequences for the clinician as well as for the patient (pewtrust.org, 2019). It is important to note that use of EHRs in physician practices and in healthcare organizations directly impacts the communication and management of laboratory information in patient care, particularly reporting of laboratory results and test order management. However, as reported by Glaser, EHRs were the fourth most common cause of burnout EHR complaints beat out insurance issues, threat of malpractice suits, concerns about salary, and patient volume (Glaser, 2017). In addition, errors from poor EHR usability can be of a great impact especially if it involves medications and delayed treatments. Intervention In addressing this challenge, one has to encourage usability by the improvement of the organization's EHR's user interface (UI) designs. There are gaps between current and future improved EHR systems designs that could have resulted from insufficient incorporation of the UI designs within several networks. Per Risvi et.al, despite the high EHR adoption rates, substantial gaps exist between the current state of EHRs and their potential usefulness. Recently, the HIT end- user community and EHR experts have pointed specifically to the cognitive challenges resulting from poor EHR usability as one of the key reasons for this gap. Also, substantial level of disparity exists around perception of HIT usage and its possible outcomes among its various users, having a wide range of technology skills further confound the situation (Rizvi et. al, 2017). Usability has been defined in various ways and typically encompasses a set of evaluation methods to understand user experiences for the purpose of creating more desirable, usable, and useful products. Many factors can affect slow usability of EHRs are user characteristics, workloads associated with progress notes typing, repeated task performance, and other subjective system assessments. There are nine principles, as reported by HIMSS, for an effective and efficient EHR usability. These nine

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    principles will be used in alignment with our proposed HIT intervention. The ultimate goal will be for the enhancement of visual display, UI design aspect, and other IT related features for the improvement of EHR usability. For this purpose, Genex Hospital EHR system will be the testing candidate. 1. Simplicity Most physicians are used to writing clinical notes in seconds but spending time to enter this information into the EHR system may seem as a heavy task thereby reducing usability. The first step is incorporating a simple user interface designs into Genex EHR system, such as an establishment of interactive patterns for the physician to document findings into the EHR. An example of such a design is a software, Story Engine, an application tool used to build and present stories. The design consists of two parts, Story builder and Story Presenter. Per hhs.gov, Story Builder is a collaborative tool; it allows user/authors to design edit and/or view each other's work while also allowing authors to work independently. Story Presenter is the Graphical User Interface (GUI) downloaded during Story Engine installation that allows patients to view stories created by Story Builder (healthit.gov, 2013). The design will enable physicians to create their entries into the system and the patient can also view the records easily. In addition, this tool contains other visual aids such as highlights, bolds, and underlining of important information, an approach that will present a clean, clutter-free screen for the users. 2. Naturalness In an effort to develop a common user guide interface style guide for users, well-known terms that are common to the workplace will be deployed into the UI system. Common features of information sources within healthcare such as clinical workflows, balances and checks for certain diagnoses, pathology, cardiology, laboratory related procedures etc. creates a natural EHR UI that are specific to the needs of the physicians. These set of common elements within the UI system will reduce the burden of frustrating searches of the end-users and leading towards better user interaction with the system. In addition, the UI system will contain a pattern of designs that allows navigation, searching from known database, and other tools such as slideshows, abstracts, scientific knowledge database, and other aspects of healthcare that establishes casual and formal impression for the end-users. This characteristic of the system will engage more clinicians with the EHR system. 3. Consistency As stated by himss.org, consistent EHR interfaces promote continuity and reduce confusion for providers (himss.org, 2019). A consistent EHR UI ensures that all parts of the system have the same look and feel, thereby enabling physicians to navigate seamlessly through the different workflows. For example, Henry stated an inconsistency in data entry, a clinician's work process

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    may make it hard or impossible to appropriately enter the desired EHR data. One case researcher analyzed showed that a clinician chose the wrong frequency for a drug to be administered because the clinician didn't realize that the order in which the options were populated into the EHR had changed (Henry, 2018). To reduce inconsistencies, certain terminologies and data entry fields compatible with the U1 will be applied in the proposed UI program. Consistency helps to reduce the learning time for the new proposed project as end users get familiar with the given experience of using the current system. In an attempt to keep a usable and user-friendly design that always provide a consistent experience, the UI design will be improved for Genex hospital EHR system while keeping the same terminologies and data entry fields. 4. Forgiveness and Feedback HIMSS simply defined this principle as "If you make a mistake, the application helps you avoid it or the application provides a method to recover from errors gracefully (the system is "forgiving"). The system provides informative feedback to the user about actions they are about to take or have taken (himss.org, 2019). There are situations where errors can occur and having a UI that allows checks and allows for correction of these errors is crucial for an effective UI. There will be an in-built checklist in the Genex improved UI design where using administrative methods such as the use of a common access card allocated to each end-user will be used to access the system. Using this encrypted card, one can track and identify errors and the system will also allow for corrections with digital signatures for verification and validity. The system will ask the end-user for confirmation, in any event of a suspected error, before allowing the action. It will be a system that allows for undo and redo of actions within the UI design. Prior to incorporating this feature into Genex EHR system, an informal usability testing will be conducted with selected end-users. These selected users will include a range of clinical and administrative Genex staff in order to gather, select, and interpret the "forgiveness and feedback" feature that will be installed into the UI design. All users will be encouraged to test in its early design and evaluate the ease of learning, effectiveness, and assess for both qualitative and quantitative satisfaction. 5. Effective Use of Language Overall, language with an effective EHR UI should read like natural English. Using the HIT intervention tool, while focusing on the physicians in a healthcare setting, effective use of language will answer the following questions: - Can the physician easily find and place orders and view results for tests? - Is it easy for the end-user to conduct and complete a patient visit while adhering to all regulatory requirements? - Are the 'human elements' applied when dealing with a patient, and not engaged with the screen throughout the patient visit?

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