Design and Evaluation of an Integrated, Patient-Focused Electronic Health Record Display for Emergency Medicine

Abstract

Background Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care. Objective This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses. Methods ED nurse and provider participants were presented various scenarios requiring patient-prioritization and care-planning tasks to be performed using the prototype display. Participants rated the display in terms of its cognitive support, usability, and usefulness. Participants' performance on the various tasks, and their feedback on the display design and utility, was analyzed. Results Participants provided ratings for usability and usefulness for the display sections using a work-centered usability questionnaire—mean scores for nurses and providers were 7.56 and 6.6 (1 being lowest and 9 being highest), respectively. General usability scores, based on the System Usability Scale tool, were rated as acceptable or marginally acceptable. Similarly, participants also rated the display highly in terms of support for specific cognitive objectives. Conclusion A novel patient-focused status display for emergency medicine was evaluated via a simulation-based study in terms of work-centered usability and usefulness. Participants' subjective ratings of usability, usefulness, and support for cognitive objectives were encouraging. These findings, including participants' qualitative feedback, provided insights for improving the design of the display.

Validation of chief complaints, medical history, medications, and physician diagnoses structured with an integrated emergency department information system in Japan: the Next Stage ER system

“…Over the last decade, the emergence of integrated emergency department information systems (EDISs) has changed emergency department (ED) administration and data management 7,8 . Multiple studies have reported the advantages of EDIS, such as improvement of usability, 9 study recruitment, 10 visual representations, 11 and data collection 12 . Several studies have utilized artificial intelligent algorithms to automatically extract structured information from clinical notes in EMRs 13,14 .…”

Human Factors and Organizational Issues

“…Want et al, [13] study concerned work-centered usability methods to evaluate integrated patient-focused status displays for Emergency Department (ED) communication and situational awareness. The study uses multiple design methods to show ED data in a prioritized and highly cognitively supporting way, using focus groups, surveying, and scenario-based study.…”

Healthcare and Aviation: Perspectives on Alerts, Machine Learning, and Future Directions

“…Providing context to alerts is critical. Effort in the field is being directed towards designing integrated displays that provide necessary context for practitioners (Wang, 2019). Interpretable models naturally align with this push for context, as they provide such context along the path towards explaining their outputs.…”