NURS 8210 HIT Usability and Design Challenges

Usability in HIT refers to the success, efficiency, and satisfaction with which specific users can attain a particular set of tasks in a specific environment. However, poor usability results in errors and challenges, which are attributed to patient harm (Ratwani et al., 2019). Usability challenges that I encountered as a clinical administrator during the implementation of the EMR in the medical center include a complicated user interface (Ball et al., 2011). There was also inadequate online assistance to help the clinicians and a poorly designed command menu that could not account for the use of short-cut keys for experienced end-users.

The complicated user interface was caused by the system developers failing to consider the design specifications provided by the end-users. Besides, the inadequate use of online assistance by clinicians was due to a lack of comprehensive training on the use of online tools present in the HIT system (Ratwani et al., 2019). The poorly designed command menu was due to the developers failing to predict the potential challenge when designing the EMR system. The challenges were a result of both poor design and implementation. Issues in the system design include the complicated user interface and poorly designed command menu (Ratwani et al., 2019). These could have been identified and prevented during the system development and testing phases. On the other hand, the ineffective use of online assistance was an implementation issue, which could have been addressed at the early stage by conducting staff training.

The challenges can be addressed by involving end-users, clinicians and nurses, at the initial stages of designing and developing the EMR system. The end users can provide insight on how the system should be designed to meet the priority needs in health care delivery (Russ & Saleem, 2018). Staff training is also crucial and should be conducted in the initial stages of implementation (Russ & Saleem, 2018). It ensures that the staff have the necessary knowledge and skills to implement the system and solve common technical challenges.

References

Ball, M. J., DuLong, D., & Hannah, K. J. (2011). Nursing informatics: where technology and caring meet.

Ratwani, R. M., Reider, J., & Singh, H. (2019). A decade of health information technology usability challenges and the path forward. Jama, 321(8), 743-744. https://doi.org/10.1001/jama.2019.0161

Russ, A. L., & Saleem, J. J. (2018). Ten factors to consider when developing usability scenarios and tasks for health information technology. Journal of biomedical informatics, 78, 123-133. https://doi.org/10.1016/j.jbi.2018.01.001

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Usability refers to the ability of individuals to utilize tools and computer applications that are specific to their environment. An example within a healthcare organization would be nurses who utilize an electronic medical record (EMR). It is expected that the EMR is user-friendly and accessible to all. This would include technology availability, capacity, as well as education/training provided (Ball et al., 2011). In the given case study, four usability challenges are present. These challenges include those which were a result of implementation such as the lack of specific training provided to staff and the minimal consideration and testing of workflow. Also present were challenges of design which included preestablished order sets and documents from other sites, and the delayed arrival of technology.

As usability allows nurses to give feedback in a structured way, it would have been appropriate to engage bedside staff within the design and implementation of the EMR (Ball et al., 2011). Within previous health information technology implementation, bedside staff have been seconded to be involved firsthand in projects. As noted in Ball et al (2011), physicians, nurses and other professionals are pivotal in all phases of the design and implementation process. Involving staff would have been beneficial to mediate the challenges regarding education and training of staff (Gruber et al., 2009). Nurses who are currently practicing in the environment are the best fit to provide information regarding order sets and documents that are frequented. Furthermore, these nurses can be super-users that staff can access if they are having issues during implementation after formal training is provided (Gruber et al., 2009). The staff should also be involved in placement of technology including bedside and nursing desk computers. By engaging staff early, this ensures that an appropriate amount of technology is ordered and will arrive in a timely manner. Another method is to ensure adequate resources is to perform a needs assessment in the earlier stages of the project (Kaufman et al., 2006).

Further challenges can be overcome by conducting usability evaluations (Ball et al., 2011). This allows for systems to be tested and redesigned as necessary to ensure a successful implementation. This would be crucial in ensuring evaluation is not an afterthought and would present as a summative approach in the later design stages of the project (Kaufman et al., 2006) In design, it is beneficial to utilize order sets and documents from other sites as these have been tested and trialed.

References

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.

Gruber, D. , Cummings, G. , Leblanc, L. & Smith, D. (2009). Factors Influencing Outcomes of

Clinical Information Systems Implementation. CIN: Computers, Informatics, Nursing, 27 (3), 151-163. doi: 10.1097/NCN.0b013e31819f7c07.

Kaufman, D. , Roberts, W. , Merrill, J. , Lai, T. & Bakken, S. (2006). Applying an Evaluation

Framework for Health Information System Design, Development, and Implementation. Nursing Research, 55 (2), S37-S42.

The assigned scenario is the implementation of an electronic medical record (EMR) system using orders, clinical documentation and results in the perinatal units of a medical center. Because of a previous implementation at another facility, the administration thought they could ‘plug and play’ the system with a six-month implementation timeline (Staggers & Toroseth, 2011). The Expanded Systems Life Cycle (ESLC) framework defines four risk areas during an implementation which include key executive support, user-driven planning, buy-in from stakeholders, use of product lines, impact on workflow, and evaluation (Gruber, Cummings, Leblanc, & Smith, 2009). Many of these aspects were not accomplished. Usability challenges included not having order sets developed specific to perinatal as a specialty. Workflow was not assessed for current state and future state. Not enough computer equipment and training was not specific to the specialty (Staggers & Toroseth, 2011).

There are multiple challenges that the implementation did not plan for ahead of time, and caused frustration for the end-users. Clinical application design (CAD) should take place throughout the system designs process. It is an iterative process including the clinicians from planning to implementation. Evidence-based ractice (EBP) specific to the clinical specialty should be integrated into the design of the application (Staggers & Toroseth, 2011). The lack of the clinical documentation and order sets into the system based on the new perinatal units at the medical center is a design issues. It should have been developed based on the EBP being used for these specific units. The workflow and the training are both implementation issues. The changes will significantly impact the clinicians and should be considered prior to the implementation. The workflow changes should be integrated into the training plans for the clinicians (Coplan & Masuda, 2011). The final implementation challenge is the ordering of workstations to be placed in the clinical units. It also could be considered a design issue. Nursing informatics (NI) functional areas include consultation and coordination, facilitation, and integration. During the implementation the NI can be used to determine the equipment to be used and placement that assists in the usability by the end users (“American Nursing Association “, 2015).

The first strategy is to use the NI in the planning and design of the system and implementation. As the NI, the role included designing the inpatient rooms and clinic areas to facilitate the usability for the clinicians. It was to determine where to place the computers, bar code scanners, and printers within the facilitate. Staggers and Troseth (2011) recommend having an informatics team with knowledge of the human factors and usability issues. The design of the system can also use the NI to work with the end users to define the needs and the characteristics of the system to make sure it includes EBP based on their patient population (Staggers & Toroseth, 2011).

The implementation of an electronic health record (EHR) is a change that includes having to learn new technology, no matter if the facility was on paper or a different EHR, and learning new workflows. Part of the implementation project is to obtain feedback from the user about the configuration of the new system and the workflow. The project team should listen to individuals who are resistant but offer improvements for the configuration or workflow (Coplan & Masuda, 2011). Mcbride (2012) studied the training and practice flows of EMR implementations, and the physicians surveyed responded that more attention needs to be made on training and the background of the trainers (McBride, 2012). Because of the specific needs for the training of the oncologists, we did not use any vendor training. Instead we brought in twelve physicians for two days of training with the clinical informatics directors who understood the workflow and had advance experience with the system. The concentration was on the basic usage and chemotherapy order sets. Every two weeks after the initial training the EMR educators rounded to give advance training the system. It was well received, and the physicians were able to function in the system. There was also a training developed that focused on physician specialty such as pulmonary, gastro, or anesthesia and the initial setup of their user profile included tools within the EHR specific to their needs. It was found that the physicians were less resistant to change, when the focus was on their “need to know” in training. This type of implementation can be done with any specialty, and the organization in the scenario could have been successful if they included configuration and training specific to perinatal units.

References

American Nursing Association (2015) Nursing Informatics: Scope and standardsof practice (2nd ed.). Silver Spring, MD: American Nursing Association.

Coplan, S., & Masuda, D. (2011). Change mangement Project management for healthcare information technology (pp. 193-237). New York, NY: McGraw Hill Companies.

Gruber, D., Cummings, G. G., Leblanc, L., & Smith, D. L. (2009).Factors influencing outcomes of clinical information systems implementation. CIN: Computers, Informatics, Nursing, 27(3), 151-163. doi:10.1097/NCN.0b013e31819f7c07

McBride, M. (2012). Training, new practice flow critical with EHR installation. Study participants share insights about the effects of the technology in their practices as they approach year mark. Medical Economics, 89(22), 36.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management (Harrow, London, England: 1994), 20(1), 32-37.

Staggers, N., & Toroseth, M. R. (2011). Usability and Clinical Application Design. In M. J. Ball, J. V. Douglas, & P. H. Walker (Eds.), Nursing Informatics: Where technology and caring meet (Fourth ed., pp. 219-241). London New York: Springer.

NURS 8210 HIT Usability and Design Challenges