Usability Testing of Two Ambulatory EHR Navigators

Hultman, Gretchen M.; Marquard, Jenna L.; Arsoniadis, Elliot G.; Mink, Pamela J.; Rizvi, Rubina F.; Ramer, Tim; Khairat, Saif; Fickau, Keri; Melton, Genevieve B.

doi:10.4338/aci-2015-10-ra-0129

Cited by 15 publications

(23 citation statements)

References 11 publications

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“…Similar to a study of another type of EHR functionality (i.e., ambulatory navigators), we observed that perceived cognitive load was unrelated to participant performance. 28 This study has several limitations that reduce its generalizability including its single organization, and relatively small sample size. Our convenience sample was limited to mid-level resident physicians which may affect generalizability.…”

Section: Discussionmentioning

confidence: 97%

Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes

et al. 2019

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Background High-quality clinical notes are essential to effective clinical communication. However, electronic clinical notes are often long, difficult to review, and contain information that is potentially extraneous or out of date. Additionally, many clinicians write electronic clinical notes using customized templates, resulting in notes with significant variability in structure. There is a need to understand better how clinicians review electronic notes and how note structure variability may impact clinicians' note-reviewing experiences. Objective This article aims to understand how physicians review electronic clinical notes and what impact section order has on note-reviewing patterns. Materials and Methods We conducted an experiment utilizing an electronic health record (EHR) system prototype containing four anonymized patient cases, each composed of nine progress notes that were presented with note sections organized in different orders to different subjects (i.e., Subjective, Objective, Assessment, and Plan, Assessment, Plan, Subjective, and Objective, Subjective, Assessment, Objective, and Plan, and Mixed). Participants, who were mid-level residents and fellows, reviewed the cases and provided a brief summary after reviewing each case. Time-related data were collected and analyzed using descriptive statistics. Surveys were administered and interviews regarding experiences reviewing notes were collected and analyzed qualitatively. Results Qualitatively, participants reported challenges related to reviewing electronic clinical notes. Experimentally, time spent reviewing notes varied based on the note section organization. Consistency in note section organization improved performance (e.g., less scrolling and searching) compared with Mixed section organization when reviewing progress notes. Discussion Clinicians face significant challenges reviewing electronic clinical notes. Our findings support minimizing extraneous information in notes, removing information that can be found in other parts of the EHR, and standardizing the display and order of note sections to improve clinicians' note review experience. Conclusion Our findings support the need to improve EHR note design and presentation to support optimal note review patterns for clinicians.

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Section: Discussionmentioning

confidence: 97%

Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes

et al. 2019

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“…Although the usability of electronic health records (EHRs) by physicians is well studied [45], little is known about the usability of electronic platforms to support dietitians’ use of patient data from apps. The Easy Diet Diary Connect platform has a comparative SUS score to evaluations of certain EHRs [46]. However, other literature has highlighted that physicians perceive EHRs to have poor usability amidst a range of other limitations relating to inefficiencies from improper integration and interference with face-to-face patient care [45].…”

Section: Discussionmentioning

confidence: 99%

Impact of Training and Integration of Apps Into Dietetic Practice on Dietitians’ Self-Efficacy With Using Mobile Health Apps and Patient Satisfaction

Chen¹,

Allman‐Farinelli²

2019

JMIR Mhealth Uhealth

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BackgroundThe use of mobile health (mHealth) apps in dietetic practice could support the delivery of nutrition care in medical nutrition therapy. However, apps are underutilized by dietitians in patient care.ObjectiveThis study aimed to determine the feasibility of an intervention consisting of education, training, and integration of apps in improving dietitians’ perceived self-efficacy with using mHealth apps.MethodsPrivate practice Accredited Practising Dietitians who were not regular users or recommenders of mHealth apps were recruited into the intervention. The intervention consisted of 2 phases: (1) a workshop that incorporated an educational lecture and skill-building activities to target self-efficacy, capability, opportunity, and motivation factors and (2) a 12-week intervention phase allowing for the integration of an app into dietetic practice via an app platform. During the 12-week intervention phase, dietitians prescribed an Australian commercial nutrition app to new (intervention) patients receiving nutrition care. Existing (control) patients were also recruited to provide a measure of patient satisfaction before the apps were introduced. New patients completed their patient satisfaction surveys at the end of the 12 weeks. Usability feedback about the app and app platform was gathered from intervention patients and dietitians.ResultsA total of 5 dietitians participated in the study. On the basis of an analysis of variance with the Tukey post hoc tests, the educational and skills training workshop component of the intervention produced immediate improvements in mean ratings for dietitians’ self-efficacy with using mHealth apps compared with baseline (P=.02), particularly with regard to familiarity with apps factor (P<.001). The self-efficacy factor integration into dietetic work systems achieved significant improvements from baseline to 12 weeks (P=.03). Patient satisfaction with dietetic services did not differ significantly between intervention (n=17) and control patients (n=13). Overall, dietitians and their patients indicated that they would continue using the app platform and app, respectively, and would recommend it to others. To improve usability, enhancing patient-dietitian communication mediums in the app platform and reducing the burden of entering in meals cooked at home should be considered.ConclusionsAdministering an educational and skills training workshop in conjunction with integrating an app platform into dietetic practice was a feasible method for improving the self-efficacy of dietitians toward using mHealth apps. Further translational research will be required to determine how the broader dietetic profession responds to this intervention.

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“…17 One strategy to address these issues has focused on redesigning EHRs, with multiple studies examining how to improve EHR usability, optimize user interfaces, and reduce click burden. 8,[18][19][20][21][22][23] However, executing EHR design changes can be constrained by limitations imposed by institutional infrastructure or by EHR vendors. Another strategy to reduce the documentation burden and altered physician-patient communication patterns imposed by EHRs is to use scribes.…”

Section: Background and Significancementioning

confidence: 99%

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

et al. 2020

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Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

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Usability Testing of Two Ambulatory EHR Navigators

Cited by 15 publications

References 11 publications

Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes

Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes

Impact of Training and Integration of Apps Into Dietetic Practice on Dietitians’ Self-Efficacy With Using Mobile Health Apps and Patient Satisfaction

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

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