HIT Usability and Design Challenges
Reflect on your experiences with the integration of new technology. How have these implementations affected the procedures that you perform at work? As the end user, it can be easy to overlook all of the important decisions that went into the finished product that you see before you. In looking at the final data management screens, you may find yourself at the crossroads of two options. You may either 1) be ecstatic about the needed change that this system brought, or 2) frustrated because you feel the system brings new hurdles into your already busy day. If you have ever experienced the latter option, the comment “I could have implemented a better system than this” may resonate strongly with you. Though research agrees that user input assists HIT designers, the development and implementation of new systems is not as straightforward as it may appear. HIT development teams find themselves in constant phases of trial and error as they strive to meet the needs of all users within the proposed development timeline. Failure to achieve promised usability benefits can lead to increased costs and job complications. Applying effective strategies to overcome usability challenges is essential.
In this week’s Discussion, you move from the standpoint of the “outsider looking in” (end user) and place yourself into a real-world implementation example. To complete this Discussion, you evaluate a case study to determine where the implementation process took a wrong turn. Use this week’s Learning Resources to propose changes that could have put this operation on the road to success.
• Review the Learning Resources, focusing on the TIGER Usability and Clinical Application Design Collaborative.
• Consider the “Best Practice Exemplars” provided in the course text Nursing Informatics: Where Technology and Caring Meet.
• Review “Case Study 1: A Usability and Clinical Application Design Challenge” presented on page 238 of the course text Nursing Informatics: Where Technology and Caring Meet.
• Determine the causes of the noted usability challenges (i.e., human factors, ergonomics, human-computer interaction), as well as potential usability concerns experienced by staff during implementation. Consider the possible design failures that lead to the usability challenges.
• What strategies might you employ to overcome these HIT usability challenges and concerns?
Case Study 1: A Usability and Clinical Application Design Challenge A medical center implemented an EMR with orders, clinical documentation, and results retrieval to improve efficiencies and enhance patient safety in the perinatal units of a small medical center, including Labor and Delivery (L&D), NICU, and Newborn Nursery Selection process • The system was installed elsewhere in this integrated delivery network • The executives wanted a fast 6-month installation at the maximum Usability challenges • Existing order sets and documents from other sites were not uploaded and tailored to this site. Clinicians were asked to input individual orders (not acceptable). • Needed computer terminals were ordered late and arrived the day of go-live. Clinicians competed for working terminals at the nurses’ stations • Workflow among units was not considered or tested. Shared information such as mother’s blood type and L&D information was not available to NICU or Newborn Nursery, causing confusion about potential patient safety issues • Generic training was given because the site tailoring was not done. On go-live, users did not know where to locate information before it had changed in the lag between training and go-live N. Staggers and M.R. Troseth Nurses and their interdisciplinary colleagues need innovative technology to simplify their work and provide them clinical guidance for the safety of their patients. This kind of inno vative technology includes usability and clinical application design principles. Usability is the fit between system users, their work, and environments. Imperatives include engaging the users early and often in the clinical systems lifecycle; understanding users, their tasks, and their environments; and conducting usability testing and redesigning before implementation. These steps better assure smooth implementations and user adop tion of complex clinical systems. Clinical application design meets systems-thinking requirements that are critical to the complex health care environments. Contemporary designs include EBP, interdisciplinary collaboration, and knowledge discovery. Good usability and clinical application design are no longer choices, but a mandate to support safe, effective decision making. All nurses – practitioners, researchers, educators, and leaders – should become aware of these principles and give voice to them at every venue where it impacts end users and patient care. Nursing informatics specialists can help educate nurses about usability. Together, nurses and nursing informatics specialists can assure excellent clinical application design to meet point-of-care practice needs for the twenty-first century. 239 Case Study 2: A Usability and Clinical Application Design Exemplar Three separate acute care hospitals in a health care system in the southern United States wanted a new clinical system after having used various systems in the past. Selection process • A Clear Vision: The new system had to support all disciplines, CPOE, EBP, and clinical decision support at the point of care. • An interdisciplinary team and leadership evaluated the system Usability/design wins • Selecting a system with a professional practice framework that was “pre-config ured” to meet vision and team requirements as well as avoid cost and time require ments for design and build • Multiple users analyzed the system: Bedside clinicians, ancillary departments; qual ity risk, legal, and management • Users identified additional content needs. These were developed and tested before implementation • The system was tested/validated for usability, design, and practice needs • Education included practice changes along with how to use the system • Developed a methodology to respond rapidly to end users Outcomes • Standardized practice in three different acute care hospitals in 15 months • Significant improvement in core measures and nurse-sensitive outcome
By Day 3 post a cohesive response to the following:
• Place yourself in the role of the clinical administrator tasked with implementing the case study’s new health information technology system.
o Evaluate the usability challenges that you faced during implementation as well as the factors that caused these challenges.
o Determine whether these challenges were a result of implementation or design.
o Formulate strategies for overcoming these usability challenges.
Course Text: Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.
• Chapter 14, “Usability and Clinical Application Design”
This chapter begins by defining the terms usability and application design as they are used in the field of nursing informatics. The authors then describe the literature review and analytic process that the TIGER Collaborative group underwent to positively transform the development of HIT systems.
Gruber, D., Cummings, G. G., LeBlanc, L., & Smith, D. L. (2009). Factors influencing outcomes of clinical information systems implementation: A systematic review. CIN: Computers, Informatics, Nursing, 27(3), 151-163.
The authors analyze the outcomes of prior IT implementations to determine if certain strategies can guarantee success when launching new clinical information systems.
Kaufman, D., Roberts, W. D., Merrill, J., Lai, T., & Bakken, S. (2006). Applying an evaluation framework for health information system design, development, and implementation. Nursing Research, 55(2, Suppl. 1), S37-S42.
This article emphasizes the indispensable role of continuous evaluation throughout the development and real-time application of new information systems into the workplace.
Schlotzer, A., & Madsen, M. (2010). Health information systems: requirements and characteristics. Studies in Health Technology & Informatics, 151, 156-166.
Use this article to examine the importance of focusing on sound design, interoperability of systems, and fulfillment of user needs when developing an effective database.