Effective medical care depends on well-designed user interfaces that enable patients, clinicians, and public health care analysts to benefit from the increasing abundance of information that supports decision making. Novel strategies in information visualization can present patients with more comprehensible personal histories and lab test reports. Cognitively effective presentations are basic, but motivating patients to adhere to treatment regimes, stop smoking, or lose weight remains a substantial challenge.; Persuasive designs and social media strategies are being tried, but reliable theories and practices are still elusive. Improved interface designs and visual analytics processes are allowing clinicians and public health care analysts to explore voluminous data in systematic yet flexible ways, so as to derive insights, make treatment decisions, and establish public health policies.
A current and significant challenge in the design and implementation of health information technology (HIT) is to deal with the high failure rate of HIT projects. Most of these failures are not due to flawed technology, but rather due to the lack of systematic considerations of human factors and other non-technology issues in the design and implementation processes. In other words, designing and implementing HIT is not so much an IT project as a project about human-centered computing akin to human-computer interaction, workflow, organizational change, and process reengineering. Due to the complexity and unique features of healthcare, human-centered methods and techniques specifically tailored for this domain are necessary for the successful development of health information systems such as electronic health records (EHRs). Good usable design would engender systems that increase efficiency and productivity, are easy to use and straight forward to learn, increase user adoption, retention, and satisfaction, and decrease medical errors, development time and cost. In this tutorial we will focus on teaching two methods appropriate for assessing EHR usability. After the half-day tutorial, the attendees should have a basic understanding of the usability issues in health IT and have gained skills enabling them to evaluate the usability of EHRs and related products using these methods
This tutorial will provide attendees with a practical approach to developing and deploying clinical decision support (CDS) interventions that measurably improve outcomes of interest to a health care delivery organization. The instructors initially will examine in detail the key building blocks of a CDS program, including creating and enhancing organizational structure for CDS success; identifying information systems for providing the data that drive CDS interventions; leveraging clinical workflow to optimize CDS interventions; processes and systems for measuring the outcomes of these interventions; and knowledge management to acquire and maintain the expert clinical and scientific knowledge that informs these interventions. The instructors then will show how to leverage these building blocks to address key steps in developing, implementing, managing and evaluating CDS interventions, including how to select interventions to deliver targeted improvements in health care; configuring those interventions in specific environments; putting the interventions into action; measuring the results of the CDS interventions and in turn refining the program based on the results. Additional discussion will touch on the role of national programs relevant to CDS, including knowledge sharing; structured guidelines; meaningful use; special considerations for CDS for small clinical practices, for hospitals and health systems and for vendors; and medico-legal considerations pertinent to CDS. Further, following interactive presentations by the instructors, attendees will divide into small groups and participate in a highly interactive exercise in planning and designing a CDS project to address a specific clinical target, facilitated by the instructors. Overall, this systematic approach to CDS implementation will be presented in an interactive, case-oriented fashion, incorporating examples provided by tutorial leaders and participants experiences. The course content is drawn from the tutorial leaders' popular and award-winning guidebook series on improving outcomes with clinical decision support, the last two volumes of which (in 2009 and 2012) were co-published by AMIA
EHR usability is a major barrier to the adoption and meaningful use of EHR. In the Proposed Rules for Meaningful Use Stage 2, usability certification will be included as one of the requirements for vendors to get their EHRs certified. After the successful Symposium on EHR Usability at AMIA 2011 with 150 attendees, SHARPC is organizing another symposium at AMIA 2012. AMIA members are invited to attend a collaborative discussion to learn about how EHR usability can be evaluated, measured, and improved to achieve meaningful use. Advanced software tools and comprehensive methods will be presented and discussed. Invited representatives from federal agencies, vendors, research institutions, and providers will provide their perspectives at this symposium.
The Strategic Health IT Advanced Research Projects (SHARP) grants were created by the Office of the National Coordinator for Health Information Technology (ONC) to address well-documented problems that impede the adoption of Health IT. The Pan-SHARP project is an initiative of the SHARP awardees to apply their technological innovations to real-world problems. The focus of the Pan-SHARP project is medication reconciliation (Med-Rec). Med-Rec aims to prevent Adverse Drug Events (ADEs) and improper medication administration, a challenge faced by nearly all healthcare providers. Med-Rec requires the construction, review, and careful curation of a patients medication lists. Today, when this activity is performed, it consumes large amounts of clinician time. Nurses, physicians, and pharmacists require between 5 and 20 minutes to perform a single reconciliation. If medication reconciliation should be performed at each transition in care, there will be a dramatic, and probably unacceptable, decrease in healthcare productivity with current solutions. The Pan-SHARP effort uses state-of-the-art technology to address these challenges. In this panel, researchers and innovators from each SHARP project will explain how their contributions will reshape Medication Reconciliation and healthcare.
Visualization and visual analytics show great potential as methods to analyze, filter, and illustrate many of the diverse data used in clinical practice. Today, (a) physicians and clinical practitioners are faced with the challenging task of analyzing large amount of unstructured, multi-modal, and longitudinal data to effectively diagnose and monitor the progression of a particular disease; (b) patients are confronted with the difficult task of understanding the correlations between many clinical values relevant to their health; and (c) healthcare organizations are faced with the problem of improving the overall operational efficiency and performance of the institution while maintaining the quality of patient care and safety. Visualization and visual analytics can potentially provide great benefits to each of these three core areas of healthcare. However, to be successful, the resulting visualization must be able to meet the physicians requirements and be useful for both patients and physicians. The goal of this panel is to present state-of-the-art visualization applications for healthcare and engage the leading physicians and clinical researchers at AMIA to discuss the areas in healthcare where additional visualization techniques are needed.
AMIAs Task Force on Usability has studied EMRs to determine how we can improve the usability of EMRs. This session tells the story of another industry's experience improving usability: aircraft cockpit design. Air travel is safer than ever despite dramatic rise in passenger miles. At the same time, the number of cockpit crew has declined even as aircraft complexity has risen. The most important lesson from commercial aviation is the way a culture of quality and safety has guided remarkably successful innovations of interactive computing in flight decks. From the top of the organization to the bottom, people at aircraft manufacturers and their customer airlines are continually aware that lives depend on their work. It may be that the most important usability issue for the EHR industry is that a similar culture of quality and safety is still evolving for information systems that support clinical health care and safety-critical decisions. This session will include a video describing contributions by aviation corporate leaders, human factors experts, pilots, engineers and others over decades that has resulted in the state today: safer flights for more people. Following the video a panel will discuss how this story might provide lessons for improving EMR usability. See the Boeing video included during this panel presentation.
To facilitate EMR adoption and meaningful use of EHR, TURF was proposed as an EHR-specific usability framework. Under TURF, a suite of usability assessment and redesign methods are under development, such as heuristic evaluation, predictive cognitive model computation, survey assessment, concept coding, TURF concept modeling and prototyping.
Several major challenges in healthcare informatics include: lack of infrastructure for clinical data sharing and large-scale analytics; obstacles to innovation in electronic health record (EHR) user interfaces; and, overwhelming volumes of information in the EHR through which physicians must sift. This panel presents work from three large projects to find solutions to these challenges, and it explores the benefits that accrue when all are integrated. Focal points of the panel include two of these integrations: connecting the i2b2 research data repository with the SMART medical app platform to improve clinical trial recruitment, and integration of patient-record summarization technology into SMART-enabled i2b2. Learning objectives for this panel: Understand the challenges in clinical data sharing and analytics, and how i2b2 is enabling these goals. Understand the SMART medical app platform and the ways it is synergistic with i2b2. Explore the challenges related to physician cognitive overload and the physician-validated models being developed for automatic summarization. Become familiar with the accrued benefit from integrating these three projects.
An expert heuristic evaluation was completed assessing five commercial EHRs. Our analyses reveal numerous violations of design principles including those with a potentially significant impact on users. We explore patient safety risks by linking observed violations within these systems and reported problems in the literature to specific heuristic principles. Our results suggest an urgent need to improve the usability of existing commercial EHRs.
Rapid Usability Assessment (RUA) was used to inspect and evaluate five commercial EHRs. We have discovered that in existing EHRs, the time for experts to perform meaningful use-related tasks are high. These times are predictive of error free performance and will likely be higher in actual clinical practice. In addition, users are likely to face numerous usability problems as they attempt to achieve meaningful use. Our results suggest an urgent need to improve the usability of existing commercial EHRs.
Bar coded medication administration (BCMA), the automated electronic verification of medications by nurses at the patient bedside, provides an additional layer of safety to the process of medication administration in the hospital setting. We performed a retrospective, descriptive study of BCMA alerts for elevated potassium (gt;5.5 mg/dL) in place within a multihospital healthcare system. Overall, 642 BCMA alerts were analyzed with a 21.3% acceptance rate. In subgroup analysis, we found that the BCMA acceptance rate was 6.9% for patients aged less than one year, and 85.6% for patients aged greater than one year. The major contributing factor to the low overall acceptance rate was the high frequency of alerts in patients less than 1 year of age. Modifications to rules logic may be necessary for this specific population. While BCMA alerts can beneficial, they should be carefully implemented with periodic post-implementation analysis and refinement.