Abstract
Usability is a critical but often overlooked factor in the design and development of healthcare information technology systems. One system increasingly being leveraged as a research and quality improvement tool is an online research portal that allows self-service access to electronic health record (EHR) data. We discuss the usability testing of such a portal through a low-cost usability inspection method: heuristic evaluation. Using heuristic evaluation methods, we identified 20 usability errors: 15.0% (3/20) were cosmetic, 35.0% (7/20) were minor, 40.0% (8/20) were major, and 10.0% (2/20) were catastrophic. Our heuristic evaluation demonstrates an affordable and efficient method to identify and correct a significant number of problems, thus improving the system using limited effort and resources. A user-friendly environment that follows accepted heuristics for good interface design is essential for ensuring accessibility and usability of data extracted from EHRs for quality improvement and research projects.
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Ash JS, Gorman PN, Seshadri V and Hersh WR (2004) Computerized physician order entry in U.S. hospitals: results of a 2002 survey. Journal of the American Medical Informatics Association 11 (2), 95–99.
Association for the Advancement of Medical Instrumentation (2010) Human Factors Engineering – Design of Medical Devices. Association for the Advancement of Medical Instrumentation, Arlington, VA.
Bates DW and Gawande AA (2003) Improving safety with information technology. New England Journal of Medicine 348 (25), 2526–2534.
Beuscart-Zephir MC, Pelayo S, Anceaux F, Maxwell D and Guerlinger S (2007) Cognitive analysis of physicians and nurses cooperation in the medication ordering and administration process. International Journal of Medical Informatics 76 (Suppl 1), S65–77.
Chan J, Shojania KG, Easty AC and Etchells EE (2011) Does user-centred design affect the efficiency, usability and safety of CPOE order sets? Journal of the American Medical Informatics Association 18 (3), 276–281.
Choi J and Bakken S (2010) Web-based education for low-literate parents in Neonatal Intensive Care Unit: development of a website and heuristic evaluation and usability testing. International Journal of Medical Informatics 79 (8), 565–575.
Chute CG, Beck SA, Fisk TB and Mohr DN (2010) The Enterprise Data Trust at Mayo Clinic: a semantically integrated warehouse of biomedical data. Journal of the American Medical Informatics Association 17 (2), 131–135.
Cockton G, Lavery D and Woolrych A (2003) Inspection-based evaluations. In The Human-Computer Interaction Handbook. Fundamentals, Evolving, Technologies and Emerging Applications (Jacko JA and Sears A, Eds, Lawrence Erlbaum Associates, Mahwah, NJ.
Edwards PJ, Moloney KP and Jacko JA (2008) Evaluating usability of a commercial electronic health record: a case study. The International Journal of Human-Computer Studies 66 (10), 718–728.
Flanagan JC (1954) The critical incident technique. Psychological Bulletin 51 (4), 327.
Folmer E and Bosch J (2002) Architecting for usability: A survey. The Journal of Systems and Software 70 (1–2), 61–78.
Gerhardt-Powels J (1996) Cognitive engineering principles for enhancing human-computer performance. International Journal of Human–Computer Interaction 8 (2), 189–211.
Graham MJ, Kubose TK, Jordan D, Zhang J, Johnson TR and Patel VL (2004) Heuristic evaluation of infusion pumps: implications for patient safety in intensive care units. International Journal of Medical Informatics 73 (11–12), 771–779.
Horvath MM, Winfield S, Evans S, Slopek S, Shang H and Ferranti J (2011) The DEDUCE guided query tool: providing simplified access to clinical data for research and quality improvement. Journal of Biomedical Informatics 44 (2), 266–276.
Hvannberg ET, Law EL and Larusdottir MK (2006) Heuristic evaluation: comparing ways of finding and reporting usability problems. Interacting with Computers 19 (2), 225–240.
Institute of Medicine Roundtable on Evidence-Based Medicine (2007) The National Academies Collection: reports funded by National Institutes of Health. In The Learning Healthcare System: Workshop Summary (Olsen, LA, Aisner, D and McGinnis, JM, Eds) National Academies Press (US), National Academy of Sciences, Washington DC.
Johnson CM, Johnson TR and Zhang J (2005) A user-centered framework for redesigning health care interfaces. Journal of Biomedical Informatics 38 (1), 75–87.
Johnson CM et al (2011) EHR Usability Toolkit: A Background Report on Usability and Electronic Health Records. Agency for Healthcare Research and Quality, Rockville, MD.
Kirwan B and Ainsworth LK (1992) A Guide to Task Analysis. Taylor & Francis, Inc., Philadelphia.
Karahoca A, Bayraktar E, Tatoglu E and Karahoca D (2010) Information system design for a hospital emergency department: a usability analysis of software prototypes. Journal of Biomedical Informatics 43 (2), 224–232.
Kramer AF, Sirevaag EJ and Braune R (1987) A psychophysiological assessment of operator workload during simulated flight missions. Human Factors 29 (2), 145–160.
Lowry SZ et al (2012) Technical evaluation, testing, and validation of the usability of electronic health records. National Institute of Standards and Technology, http://www.nist.gov/healthcare/usability/upload/EUP_WERB_Version_2_23_12-Final-2.pdf.
McDonald CJ (1997) The barriers to electronic medical record systems and how to overcome them. Journal of the American Medical Informatics Association 4 (3), 213–221.
Mirel BR, Wright Z, Tenenbaum JD, Saxman P and Smith KA (2010) User requirements for exploring a resource inventory for clinical research. AMIA Summits on Translational Science Proceedings, pp 31–35.
Newman WM (1998) On simulation, measurement, and piecewise usability evaluation. Human–Computer Interaction 13 (3), 316–323.
Nielsen J (1993) Usability Engineering. Academic Press, Boston.
Polson PG, Lewis C, Rietman J and Wharton C (1992) Cognitive walkthroughs: a method for theory-based evaluation of user interfaces. International Journal of Man-Machine Studies 35 (5), 741–773.
Polson P and Lewis CH (1990) Theory-based design for easily learned interfaces. Human–Computer Interaction 5 (2), 191–220.
Roden DM et al (2008) Development of a large-scale de-identified DNA biobank to enable personalized medicine. Clinical Pharmacology & Therapeutics 84 (3), 362–369.
Rosenbloom ST et al (2005) Effect of CPOE user interface design on user-initiated access to educational and patient information during clinical care. Journal of the American Medical Informatics Association 12 (4), 458–473.
Schneiderman B and Plaisant C (2010) Designing the User Interface. Strategies for Effecting Human Computer Interaction, 5th edn, Addison Wesley Longman, Inc., Boston.
Shachak A, Hadas-Dayagi M, Ziv A and Reis S (2009) Primary care physicians’ use of an electronic medical record system: a cognitive task analysis. Journal of General Internal Medicine 24 (3), 341–348.
Sittig DF, Krall M, Kaalaas-Sittig J and Ash JS (2005) Emotional aspects of computer-based provider order entry: a qualitative study. Journal of the American Medical Informatics Association 12 (5), 561–567.
Sox CM, Gribbon WM, Loring BA, Mandl KD, Batista R and Porter SC (2010) Patient-centered design of an information management module for a personally controlled health record. Journal of Medical Internet Research 12 (3), e36.
Tang PC and Patel VL (1994) Major issues in user interface design for health professional workstations: summary and recommendations. Interntional Journal of Biomedical Computing 34 (1–4), 139–148.
Thyvalikakath TP, Monaco V, Thambuganipalle H and Schleyer T (2009) Comparative study of heuristic evaluation and usability testing methods. Studies in Health Technology and Informatics 143, 322–327.
West R and Lehman KR (2006) Automated summative usability studies: an empirical evaluation. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, Montreal, CA.
Zhang J, Johnson TR, Patel VL, Paige DL and Kubose T (2003) Using usability heuristics to evaluate patient safety of medical devices. Journal of Biomedical Informatics 36 (1–2), 23–30.
Zhang J and Walji MF (2011) TURF: toward a unified framework of EHR usability. Journal of Biomedical Informatics 44 (6), 1056–1067.
Acknowledgements
We would like to thank Shelley Rusincovitch and the Duke Health Technology Solutions Management Team for their help and support. This publication was made possible by Grant Number UL1RR024128 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCRR or Duke University.
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Shaw, R., Horvath, M., Leonard, D. et al. Developing a user-friendly interface for a self-service healthcare research portal: cost-effective usability testing. Health Syst 4, 151–158 (2015). https://doi.org/10.1057/hs.2014.26
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DOI: https://doi.org/10.1057/hs.2014.26