A Heuristic Evaluation to Assess Use of After Visit Summaries for Supporting Continuity of Care

Tremoulet, Patrice D.; Krishnan, Ramya; Karavite, Dean; Muthu, Naveen; Regli, Susan Harkness; Javernick‐Will, Amy; Michel, Jeremy J.

doi:10.1055/s-0038-1668093

Cited by 8 publications

(17 citation statements)

References 31 publications

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“…First, the data requirements of outpatient providers who coordinate care for elderly patients were identified through an exploratory, descriptive effort, and the knowledge gleaned from that effort was applied to specify 2 new guidelines for creating useful DSs. Second, the new guidelines were combined with 17 previously developed medical documentation usability heuristics [ 7 ] (see Multimedia Appendix 1 ) and applied to assess how well 4 examples of elderly patient discharge summaries support care coordination. The second part not only shed light on how difficult it can be for outpatient providers to use the discharge summaries currently being produced by inpatient providers’ EHRs but also yielded several recommendations for improving the quality of EHR-generated discharge summaries.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical experts were also given the opportunity to report any additional issues they found in the simulated discharge summaries. This iterative approach to heuristic evaluation, which reduces the time required by clinical experts, has been used successfully to evaluate medical technology [ 7 , 23 ]. This approach is also consistent with Nielsen’s recommendation that experts first be asked to use heuristics to identify issues and later be asked to rate the severity of all issues [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…The human factors team was given a set of 19 assessment tools: 17 previously developed medical document usability heuristics [ 7 ] (see Multimedia Appendix 1 ) and the 2 new discharge summary content guidelines (see Results section) and instructions on how to apply the heuristics to assess discharge summaries. The 5 human factors team members independently identified potential usability issues by looking for violations of the heuristics or the guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…We adapted Sauro’s 3-point scale [ 25 ] by adding a level 0 for “not an issue” and then replacing the term “critical” with the word “severe” for level 3. The latter change was intended to prevent participants from avoiding use of that rating; in prior work, some clinicians were reluctant to use “critical,” reserving that for issues that indisputably cause harm [ 7 ]. Table 1 describes the levels and provides an example of an issue at each level.…”

Section: Methodsmentioning

confidence: 99%

“…Other work has shown that updating EHRs is a burden for many outpatient providers [ 5 , 6 ]. However, few researchers have explored how inpatient providers’ adoption of EHRs impacted outpatient clinicians’ ability to assimilate information about recently discharged patients [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Usability of Electronic Health Record–Generated Discharge Summaries: Heuristic Evaluation

Tremoulet¹,

Shah²,

Acosta³

et al. 2021

J Med Internet Res

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Background Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. Objective This study aimed to (1) identify the information about elderly patients’ recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)–generated discharge summaries, thereby increasing patient safety. Methods A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. Results The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 “helpful, but not always necessary” items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. Conclusions Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition–related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Usability of Electronic Health Record–Generated Discharge Summaries: Heuristic Evaluation

Tremoulet¹,

Shah²,

Acosta³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

show abstract

Design for effective care collaboration

2020

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Clinical decision support for intervention reduction in neonatal patients: A usability assessment

Tremoulet

2022

DIGITAL HEALTH

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Objective This study investigated how effectively simplified cognitive walkthroughs, performed independently by four nonclinical researchers, can be used to assess the usability of clinical decision support software. It also helped illuminate the types of usability issues in clinical decision support software tools that cognitive walkthroughs can identify. Method A human factors professor and three research assistants each conducted an independent cognitive walkthrough of a web-based demonstration version of T3, a physiologic monitoring system featuring a new clinical decision support software tool called MAnagement Application (MAP). They accessed the demo on personal computers in their homes and used it to walk through several pre-specified tasks, answering three standard questions at each step. Then they met to review and prioritize the findings. Results Evaluators acknowledged several positive features including concise, helpful tooltips and an informative column in the patient overview which allows users direct (one-click) access to protocol eligibility and compliance criteria. Recommendations to improve usability include: modify the language to clarify what user actions are possible; visually indicate when eligibility flags are snoozed; and specify which protocol's data is currently being shown. Conclusion Independent, simplified cognitive walkthroughs can help ensure that clinical decision support software tools will appropriately support clinicians. Four researchers used this technique to quickly, inexpensively, and effectively assess T3's new MAP tool, which suggests positive actions, such as removing a patient from a ventilator. Results indicate that, while there is room for usability improvements, the MAP tool may help reduce clinician's cognitive load, facilitating improved care. The study also confirmed that cognitive walkthroughs identify issues that make clinical decision support software hard to learn or remember to use.

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A Heuristic Evaluation to Assess Use of After Visit Summaries for Supporting Continuity of Care

Cited by 8 publications

References 31 publications

Usability of Electronic Health Record–Generated Discharge Summaries: Heuristic Evaluation

Usability of Electronic Health Record–Generated Discharge Summaries: Heuristic Evaluation

Design for effective care collaboration

Clinical decision support for intervention reduction in neonatal patients: A usability assessment

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