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| − | == Objectives ==
| + | #REDIRECt [[An interface-driven analysis of user interactions with an electronic health records system]] |
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| − | This was a study that investigated user interactions or experience with an [http://www.himss.org/library/ehr/ Electronic Health Record (EHR)] system called the Clinical Reminder System (CRS) in terms of its user interface (UI) and application Flow (AF) design. <ref name="Kai Zheng, et. al"> Kai Zheng, et. al. An Interface Driven Analysis of User Interactions with an Electronic Health Records System. Journal of the American Medical Informatics Assoc. (2009). 16: 228-237 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649313/</ref>
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| − | == Research Questions ==
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| − | Do [[user interface]] (UI) and application flow (AF) design deficiencies influence end users’ day-to-day clinical practice? Does a poor fit between UI/AF designs influence the way clinicians navigate through an [http://www.himss.org/library/ehr/ EHR] system? Can user behavior be used to improve the system’s [[Usability|usability]]? <ref name="Kai Zheng, et. al"> Kai Zheng, et. al. An Interface Driven Analysis of User Interactions with an Electronic Health Records System. Journal of the American Medical Informatics Assoc. (2009). 16: 228-237 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649313/</ref>
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| − | == Methods ==
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| − | === Environment ===
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| − | The study site used was West Penn Medical Associates, an ambulatory primary care clinic at Western Pennsylvania hospital, a teaching hospital where all primary users were internal medicine residents. <ref name="Kai Zheng, et. al"> Kai Zheng, et. al. An Interface Driven Analysis of User Interactions with an Electronic Health Records System. Journal of the American Medical Informatics Assoc. (2009). 16: 228-237 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649313/</ref>
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| − | === Design ===
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| − | Recurring UI navigational patterns were uncovered using sequential pattern analysis (SPA) and a first-order [http://ipht.cea.fr/Docspht/articles/t06/074/public/publi.pdf Markov chain model]. SPA was used to search for recurring patterns; consecutive [http://www.himss.org/library/ehr/ EHR] features access events at given points in time. [http://www.himss.org/library/ehr/ EHR] usage patterns and data were recorded and analyzed during a 10-month period.<ref name="Kai Zheng, et. al"> Kai Zheng, et. al. An Interface Driven Analysis of User Interactions with an Electronic Health Records System. Journal of the American Medical Informatics Assoc. (2009). 16: 228-237 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649313/</ref>
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| − | === Measurements ===
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| − | Using the [http://www.himss.org/library/ehr/ EHR's] transaction database, the study utilized computer-recorded event sequences of different features of the [http://www.himss.org/library/ehr/ EHR] by users to show patterns in the way they were accessed. <ref name="Kai Zheng, et. al"> Kai Zheng, et. al. An Interface Driven Analysis of User Interactions with an Electronic Health Records System. Journal of the American Medical Informatics Assoc. (2009). 16: 228-237 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649313/</ref>
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| − | == Results ==
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| − | In all, seventeen main [http://www.himss.org/library/ehr/ EHR] features were recorded. During the study period, users of CRS recorded 973 patient encounters. Using the transaction database of CRS, sequential patterns across encounter sessions were constructed and data analyzed. Patterns of consecutive feature access events were recorded; eleven were identified as maximal with levels of support ranging from 15 to 51.16 percent; Within-session recurring rates of sequential patterns showed levels of support between 51.35 and 70.22 percent. <ref name="Kai Zheng, et. al"> Kai Zheng, et. al. An Interface Driven Analysis of User Interactions with an Electronic Health Records System. Journal of the American Medical Informatics Assoc. (2009). 16: 228-237 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649313/</ref>
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| − | == Conclusion ==
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| − | User interface (UI) and application flow (AF) design deficiencies may influence end users’ day-to-day clinical practice. Poor fit between UI/AF designs may influence the way clinicians navigate through an [http://www.himss.org/library/ehr/ EHR] system. Users demonstrated consistent UI navigational patterns when performing different clinical tasks. Some of these patterns deviated from the [http://www.himss.org/library/ehr/ EHR] system’s original UI/AF design principles. User behavior and such deviations should be considered when designing health information technology (HIT) systems. <ref name="Kai Zheng, et. al"> Kai Zheng, et. al. An Interface Driven Analysis of User Interactions with an Electronic Health Records System. Journal of the American Medical Informatics Assoc. (2009). 16: 228-237 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649313/</ref>
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| − | == Comments ==
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| − | UI/AF design has the tendency to influence how the user navigates an [http://www.himss.org/library/ehr/ EHR] system. UI navigational patterns might have an effect on clinical practice. End users may not have the full benefits of an [http://www.himss.org/library/ehr/ EHR] implementation from poorly designed UI and AF. When this happens, decreased time efficiency, coupled with user dissatisfaction can adversely affect the quality of care and patient safety. Superior user experience is eminent with appealing, intuitive UI and AF designs. User behavior can be used to improve an [http://www.himss.org/library/ehr/ EHR] system’s usability.
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| − | == References ==
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| − | <references/>
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| − | [[Category:Reviews]]
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| − | [[Category:EHR]]
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| − | ==Second Review==
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| − | ===Objectives===
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| − | The study was to expose and evaluate the different patterns in user interactions (UI) and applications flow (AF) of an Information System namely Clinical Reminder System (CRS) which was re-engineered to meet the clinical practice end users.<ref name="Zheng"> Zheng K., Padman R., Johnson M. P., Diamond H.S. 2009 An Interface-driven Analysis of User Interactions with an Electronic Health Records System. Journal of the American Medical Informatics Association 16(2), 228 –237.</ref>
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| − | ===Design===
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| − | [http://www.himss.org/library/ehr/ EHR] was integrated to capture comprehensive UI interaction events. The events were recorded based on time in sequences. The study site was an ambulatory primary care clinic in West Penn Medical Associates, part of Western Pennsylvania Hospital. [http://www.himss.org/library/ehr/ EHR's] were primarily accessed by Internal medicine residents.<ref name="Zheng"></ref>
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| − | ===Measurements===
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| − | Over 10 month period, sequences of events for usage of generic [http://www.himss.org/library/ehr/ EHR] features in CRA were retrieved from the [http://www.himss.org/library/ehr/ EHR's] transaction database, which are feature labelled and chronologically ordered.<ref name="Zheng"></ref>
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| − | ===Methods===
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| − | The study used Sequential Pattern Analysis (SPA) and First-order Markov Chain Analysis, along with Analysis of Within-session Recurrence Rates to evaluate recurring UI navigational patterns.<ref name="Zheng"></ref>
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| − | ===Results===
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| − | Of the 17 main features identified, 70% of them consisted of “Assessment and Plan” (21.18%), “Order” (17.17%), “Diagnosis” (16.36%), and “Medication” (14.53%). The SPA uncovered 11 maximal sequential patterns and the most frequently used packed features were “Assessment and Plan” and “Diagnosis,” “Order” and “Medication,” and “Order” and “Laboratory Test.”. These were consistent when assessed within-session recurrence rate. The 7-Step Markov Chain displayed an [http://www.himss.org/library/ehr/ EHR] Feature Spectrum, where “History of Present Illness”, “Social History”, “Assessment and Plan” were consistently accessed among other features.<ref name="Zheng"></ref>
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| − | ===Discussion===
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| − | Two important areas were observed for the imbalance between the in practice user’s navigational pathway and anticipated pathway in the original UI/AF designed.
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| − | One was unexpected individual user discernment in usage of features rather than following the standards. Another was easy and immediate accessibility on screen for most important features to be placed in such a manner that there is smooth flow of sequence of patterns.<ref name="Zheng"></ref>
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| − | ===Conclusion===
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| − | Although the study highlighted the consistency in navigational patterns of different clinical tasks which was intended as per the designed UI/AF but the unexpected user behavior should be evaluated and any benefits if recognized, incorporated for the improvement of [http://www.himss.org/library/ehr/ EHR] features.Also deviations from recommended standards by clinicians to their actual clinical practice must be carefully addressed in the health IT design and implementation processes. <ref name="Zheng"></ref>
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| − | ===Comments===
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| − | I am attracted to the Zheng et al., highlighting of UI layout features a unique design in which all essential [http://www.himss.org/library/ehr/ EHR] features are placed in a single workspace in view of cognitive continuity when users navigate from one [http://www.himss.org/library/ehr/ EHR] feature to another. It could alleviate the display and UI problems.
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| − | [[Category:Reviews]]
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| − | [[Category:EHR]]
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| − | ==References==
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| − | <references/>
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