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Usability of Health Information Systems

The ever-growing health information generated by providers and physicians is managed by health information (HIT) systems. Health information technologies have revolutionized our health care systems. Software such as EHR (electronic health records) have introduced a new dimension in our health industry. We tend to see a lot of buzz around technologies and trends. There are many different types of HIT systems ranging from the development of administrative systems containing patient’s history, details and appointments to systems that support and manage different diagnoses like CPOE.

In conjunction with HIT, ICT (information and communication technology) is used in every domain and facet of the healthcare system from diagnoses to prescription and clinical care. The usage of ICT brings:

  • Increased accuracy
  • Speed of access
  • Portability
  • Remote access
  • Location awareness
  • Higher precision
  • Management of huge mass of data

In simple words what is usability? What is the first thought that comes to mind when the word usability pops up? It is a set of evaluation methods that understands and interprets user experience to create a product that is more accessible, desirable and useful for the customer to use. It should be a user-centred design, the product should be easy to use and understandable by the user rather than the user should get used to the final product. International Organization for Standardization (ISO) defines usability as, “an extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use.” User-centred design in usability I think most providers will agree on this formal definition of usability and it turns out they are robust to achieve usability through user-centred design. Of course, there are other methods as well to achieve usability but the user-centred design seems to be successful in several industries. It is about putting the needs of the end-user at the forefront of the design and development process. It can be achieved by; Identifying users’ needs, understand the clinical environment and how clinicians actually work developing some initial wireframes and then consistently and continually moderating such that every time you are advancing your product through development, you’re getting feedback and building upon it. Nielson defined usability in five steps

  • easy to learn
  • easy to remember
  • efficient
  • having minimal errors
  • great user satisfaction

Physicians and medical practitioners encounter different problems and errors while using HIT software. The factors, characteristics and approach should be kept in mind while developing a HIT system. Usability factors that are crucial in the health care system, and should not be avoided during the development of a system or software are as follows:

  • Error prevention
  • Patient safety
  • Patient privacy

What are the two important bins of usability?

  • User interface control, displays and control screen design, clicks and tags
  • Cognitive task support, “Workflow design” data visualization functionality

These two bins overlap intermittently, currently, usability is one of the most highlighted topics in the human-computer interaction system. It is a quality system and due to its justification and significance, it is not only related to e-commerce but a wide array of systems including health care.

Importance of usability in health care systems The most prominent part of HIT is EHR. The most precise way to test the efficiency of this software is to evaluate the usability of the software. The trials for testing and evaluating program software should be implemented from the beginning, the errors should be rectified during the experimental process. If this step is delayed, then the changes and problems are huge to solve and would probably result in high expenses.

The end-user HIT systems success or failure depends on the usage of the end-user, whether it is being used completely or partially. Poor user experience within the health care industry results from an inability of the end-user and software to co-operate with each other, there is a possibility that software is hard to use and the user experience is time-consuming leaving the customer frustrated and dissatisfied with the overall experience. The program may require a redesign which could be highly costly for the industry. And if an organization/institution purchases a system with poor usability, there is no returning or refund either it requires a redesign or just develop a whole new system dumping the previous one.

This results in errors in medical information collected from consumer, impeded functionality, lack of availability of authentic information and bad user response causing a loss in the flow of customers overall. There are five ways to detect the overall user experience

  • User by function
  • User by nature of use
  • User by skill level
  • User by discretion
  • User by developmental role

Dimensions of usability in the health care industry Usability has three dimensions in the light of the International Organization of Standardization ISO definition; “Accuracy and completeness with which users achieve specified goals”. These dimensions are:

  • Effectiveness
  • Efficiency
  • Satisfaction

Now I am going to briefly explain these.

Effectiveness It is a measure in the HIT system, to evaluate that the IT system works perfectly in conjunction with the task to be performed by medical practitioners. It refers to the number of work function available in the HIT compared to the number of work function in the job. For instance, HIT can be used to manage vaccination and immunizations, by managing alerts and notifying if the person has missed the immunization schedule.

The factors of effectiveness measures are:

  • Work domain saturation
  • Task completion
  • Accuracy
  • Recall
  • Quality of outcome
  • Expert assessment

Efficiency It is designed in a manner to assess how easy it is to use the HIT system for the user. This is achieved by introducing:

  • specific tasks
  • different trials for a specific task
  • time spent on each task
  • input rate

The efficiency of the system can be assessed by evaluating and designing a system that requires minimum mental effort and thinking by the individual, achieving success in tasks in a short period by consumer indicates the efficiency of the HIT system. A certain usage pattern is introduced and studied by the software developer to help navigate what the user is trying to achieve or want to perform the task in the app, this helps to increase the accessibility and efficiency of the system. This way the system providers can understand user demand and introduce related tasks. This results in a reduced encounter of systemic errors.

The factors of efficiency include:

  • Learnability
  • Time
  • Input rate
  • Mental effort
  • Usage patterns
  • Error prevention
  • Expert assessment

Accuracy The HIT systems reduce errors in the prescription, i-e reducing medication errors allowing better drug management. It also helps in monitoring the drug that is administered and detects any sort of drug allergy. Because electronic records have excellent precision, presentation and legibility allowing a high level of detail, it significantly reduces ambiguity and transcription errors.

Quality of care The quality of care for the patient is increased by health care providers using the HIT systems. It requires physicians and providers to look into the detail of the disease patient is suffering from, helping to diagnose the disease earlier and treat it before it gets out of hands. Availability of information

HIT systems enhance the ease and availability of clinical information. Problems related to the unavailability of medical record and distance are eliminated through this system. Its vast array of technology has minimized and reduced the need for paper records as they are hard to read and lack the basic structure of patient data to find relevant information for the treatment of current problem faced by the patient. The paper record might be incomplete in:

  • Reporting
  • Organizing
  • Locating clinical information

With this factor, the information is available and accessible to the provider irrespective of the distance barrier. The HIT system generates computerized clinical notes that follow a specific format and clinicians can easily navigate through extensive data and extract desired information. It is highly flexible and dynamic which enables clinicians to modify and add more information to the system at any time.

Satisfaction This is a subjective dimension of usability and is related to the user’s approval for the HIT. This achieved by introducing questionnaires and recording the feedback collected by customers or users. These questioners can assess and perceive users

  • Ease of use
  • The usefulness of the system
  • Ease of learning
  • Satisfaction with the task completed
  • Overall satisfaction from the HIT system

The user is asked either to rank the features introduced in the system or require feedback on the features, services and tools offered in the system. The scales used to assess satisfaction in usability are:

  • Likert rating scale
  • Semantic differential scale

Implementation of health information technology system Despite the enormous benefits of HIT systems, there are still many challenges faced by the system in the implementation process. The main challenge faced by HIT is appropriate and accountable access via necessary standardization to the HIT on the EHR.

There are certain barriers faced by HIT system despite their multitude of benefits, these are:

  • System failure
  • Cost
  • Fear of confidentiality
  • Security and privacy
  • Inefficiency
  • Poorer quality of health care
  • Changes in the work process
  • The complexity of health care
  • Lack of acceptance by clinicians

Phases of usability testing

  • Planning

Planning is the first and foremost important step in testing. The provider executes a plan based on the requirements of the user and sketches a program. It is performed in the early stages of making the user-centred program. In this step, usability is focused on users’ needs it provides a framework for designers and developers in building the system.

  • Designing

The developing and designing team works together to build a prototype, parallel designing and storyboard for the app, that is user friendly.

  • Testing

After the development of the prototype, the process of testing starts, which involves users that are intended to use this system. the main point of testing is to achieve a quality user experience and improve the HIT system. Methods for Testing include:

  • Cognitive walkthroughs
  • User Surveys
  • Satisfaction questionnaires
  • Weekly user interview
  • Daily logs

What are the problems faced in the usability of health care systems? Health care workers and medical practitioners are greatly experiencing errors in the HIT systems. They are highly dissatisfied with how the systems work and display the clinical information. These systems are complex and have disrupted navigation system, the user is unable to locate useful information as it heads to somewhere else and displays information that is not useful during the diagnosis. The Healthcare Information and Management Systems Society (HIMSS) Electronic Health Record Usability Task Force reported that Usability is the sole factor that is hindering the process of user experience and user interface. I am referring to things like interoperability clinician burnout from EHR etc. One major issue is still clinical usability we have been at this for about forty-two years trying to focus on clinical usability there are about a hundred thousand physicians using HIT system at the point of care in various products so we get flooded with information about what clinicians would like to see etc.

Usability and provider satisfaction Clinical data is going to be the key moving forward for usability and physician satisfaction. The future of HIT system relies on the clinical application using mobile devices:

  • Poorly developed usability documentation modules create errors ad inefficiencies that fuel physician burnout.
  • Data sharing between different systems is mixed and is difficult to evaluate without clean data, most people called it data tsunami and it is difficult for the physician to find relevant information from scattered data especially when there is an increased workload.
  • The information needed by the provider to evaluate a patient should be present in front of the provider when it’s needed so that they have cognitive clinical clarity, and they can see all the relevant information for a conditioned problem instantly.

Electronic health record The HER is an important domain and tool of HIT for providing a user-centred information-rich environment. It is defined as: An electronic longitudinal collection of personal healthcare information, usually based on the individual, entered or accepted by the healthcare provider, can be distributed over several sites or aggregated at a particular source. This information is organised primarily to support continuing, efficient and quality health care. The record is under the control and is stored and transmitted securely.

Takeaway HIT system is a revolutionary adaptation in our health care system. The most important factor is the usability of the system, how easily the system is accessible to the user and ease of access to use the system by all sorts of patients. Usability testing in HIT system is a crucial step as it detects the user relationship with the application software being used, early detection of errors can help rectify the problem user is experiencing. The sole purpose of usability is to enhance user experience and ease of usage for the user along with continuous improvement in the design and function of the HIT system.


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