Kabir Yadav1, James M Chamberlain2, Vicki R Lewis3, Natalie Abts4, Shawn Chawla5, Angie Hernandez6, Justin Johnson7, Genevieve Tuveson8, Randall S Burd8. 1. Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA. 2. Division of Emergency Medicine, Children's National Medical Center, Washington, DC. 3. Healthcare Safety Strategies, LLC, Blacksburg, VA. 4. MedStar Institute for Innovation, National Center for Human Factors in Healthcare, Washington, DC. 5. George Washington University School of Medicine and Health Sciences, Washington, DC. 6. Design Interactive, Oviedo, FL. 7. Drexel University College of Medicine, Philadelphia, PA. 8. Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC.
Abstract
BACKGROUND: Use of electronic clinical decision support (eCDS) has been recommended to improve implementation of clinical decision rules. Many eCDS tools, however, are designed and implemented without taking into account the context in which clinical work is performed. Implementation of the pediatric traumatic brain injury (TBI) clinical decision rule at one Level I pediatric emergency department includes an electronic questionnaire triggered when ordering a head computed tomography using computerized physician order entry (CPOE). Providers use this CPOE tool in less than 20% of trauma resuscitation cases. A human factors engineering approach could identify the implementation barriers that are limiting the use of this tool. OBJECTIVES: The objective was to design a pediatric TBI eCDS tool for trauma resuscitation using a human factors approach. The hypothesis was that clinical experts will rate a usability-enhanced eCDS tool better than the existing CPOE tool for user interface design and suitability for clinical use. METHODS: This mixed-methods study followed usability evaluation principles. Pediatric emergency physicians were surveyed to identify barriers to using the existing eCDS tool. Using standard trauma resuscitation protocols, a hierarchical task analysis of pediatric TBI evaluation was developed. Five clinical experts, all board-certified pediatric emergency medicine faculty members, then iteratively modified the hierarchical task analysis until reaching consensus. The software team developed a prototype eCDS display using the hierarchical task analysis. Three human factors engineers provided feedback on the prototype through a heuristic evaluation, and the software team refined the eCDS tool using a rapid prototyping process. The eCDS tool then underwent iterative usability evaluations by the five clinical experts using video review of 50 trauma resuscitation cases. A final eCDS tool was created based on their feedback, with content analysis of the evaluations performed to ensure all concerns were identified and addressed. RESULTS: Among 26 EPs (76% response rate), the main barriers to using the existing tool were that the information displayed is redundant and does not fit clinical workflow. After the prototype eCDS tool was developed based on the trauma resuscitation hierarchical task analysis, the human factors engineers rated it to be better than the CPOE tool for nine of 10 standard user interface design heuristics on a three-point scale. The eCDS tool was also rated better for clinical use on the same scale, in 84% of 50 expert-video pairs, and was rated equivalent in the remainder. Clinical experts also rated barriers to use of the eCDS tool as being low. CONCLUSIONS: An eCDS tool for diagnostic imaging designed using human factors engineering methods has improved perceived usability among pediatric emergency physicians.
BACKGROUND: Use of electronic clinical decision support (eCDS) has been recommended to improve implementation of clinical decision rules. Many eCDS tools, however, are designed and implemented without taking into account the context in which clinical work is performed. Implementation of the pediatric traumatic brain injury (TBI) clinical decision rule at one Level I pediatric emergency department includes an electronic questionnaire triggered when ordering a head computed tomography using computerized physician order entry (CPOE). Providers use this CPOE tool in less than 20% of trauma resuscitation cases. A human factors engineering approach could identify the implementation barriers that are limiting the use of this tool. OBJECTIVES: The objective was to design a pediatric TBI eCDS tool for trauma resuscitation using a human factors approach. The hypothesis was that clinical experts will rate a usability-enhanced eCDS tool better than the existing CPOE tool for user interface design and suitability for clinical use. METHODS: This mixed-methods study followed usability evaluation principles. Pediatric emergency physicians were surveyed to identify barriers to using the existing eCDS tool. Using standard trauma resuscitation protocols, a hierarchical task analysis of pediatric TBI evaluation was developed. Five clinical experts, all board-certified pediatric emergency medicine faculty members, then iteratively modified the hierarchical task analysis until reaching consensus. The software team developed a prototype eCDS display using the hierarchical task analysis. Three human factors engineers provided feedback on the prototype through a heuristic evaluation, and the software team refined the eCDS tool using a rapid prototyping process. The eCDS tool then underwent iterative usability evaluations by the five clinical experts using video review of 50 trauma resuscitation cases. A final eCDS tool was created based on their feedback, with content analysis of the evaluations performed to ensure all concerns were identified and addressed. RESULTS: Among 26 EPs (76% response rate), the main barriers to using the existing tool were that the information displayed is redundant and does not fit clinical workflow. After the prototype eCDS tool was developed based on the trauma resuscitation hierarchical task analysis, the human factors engineers rated it to be better than the CPOE tool for nine of 10 standard user interface design heuristics on a three-point scale. The eCDS tool was also rated better for clinical use on the same scale, in 84% of 50 expert-video pairs, and was rated equivalent in the remainder. Clinical experts also rated barriers to use of the eCDS tool as being low. CONCLUSIONS: An eCDS tool for diagnostic imaging designed using human factors engineering methods has improved perceived usability among pediatric emergency physicians.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Byron J Powell; J Curtis McMillen; Enola K Proctor; Christopher R Carpenter; Richard T Griffey; Alicia C Bunger; Joseph E Glass; Jennifer L York Journal: Med Care Res Rev Date: 2011-12-26 Impact factor: 3.929
Authors: Alice C Li; Joseph L Kannry; Andre Kushniruk; Dillon Chrimes; Thomas G McGinn; Daniel Edonyabo; Devin M Mann Journal: Int J Med Inform Date: 2012-03-27 Impact factor: 4.046
Authors: Ian G Stiell; Catherine M Clement; Jeremy Grimshaw; Robert J Brison; Brian H Rowe; Michael J Schull; Jacques S Lee; Jamie Brehaut; R Douglas McKnight; Mary A Eisenhauer; Jonathan Dreyer; Eric Letovsky; Tim Rutledge; Iain MacPhail; Scott Ross; Amit Shah; Jeffrey J Perry; Brian R Holroyd; Urbain Ip; Howard Lesiuk; George A Wells Journal: BMJ Date: 2009-10-29
Authors: Megan E Salwei; Peter Hoonakker; Pascale Carayon; Douglas Wiegmann; Michael Pulia; Brian W Patterson Journal: Hum Factors Date: 2022-04-14 Impact factor: 3.598
Authors: Dustin W Ballard; Ridhima Vemula; Uli K Chettipally; Mamata V Kene; Dustin G Mark; Andrew K Elms; James S Lin; Mary E Reed; Jie Huang; Adina S Rauchwerger; David R Vinson Journal: Appl Clin Inform Date: 2016-09-21 Impact factor: 2.342