Design of Electronic Medical Record User Interfaces: A Matrix-Based Method for Improving Usability

Kuqi, Kushtrim; Eveleigh, Tim; Holzer, Thomas; Sarkani, Shahryar; Levin, James E.; Crowley, Rebecca S.

doi:https://doi.org/10.1260/2040-2295.4.3.427

Journal of Healthcare Engineering

On this page

Abstract References Copyright Related Articles

Research Article | Open Access

Volume 4 | Article ID 960743 | https://doi.org/10.1260/2040-2295.4.3.427

Design of Electronic Medical Record User Interfaces: A Matrix-Based Method for Improving Usability

Kushtrim Kuqi,¹Tim Eveleigh,¹Thomas Holzer,¹Shahryar Sarkani,¹James E. Levin,²and Rebecca S. Crowley³

Received01 Dec 2012

Accepted01 Apr 2013

Abstract

This study examines a new approach of using the Design Structure Matrix (DSM) modeling technique to improve the design of Electronic Medical Record (EMR) user interfaces. The usability of an EMR medication dosage calculator used for placing orders in an academic hospital setting was investigated. The proposed method captures and analyzes the interactions between user interface elements of the EMR system and groups elements based on information exchange, spatial adjacency, and similarity to improve screen density and time-on-task. Medication dose adjustment task time was recorded for the existing and new designs using a cognitive simulation model that predicts user performance. We estimate that the design improvement could reduce time-on-task by saving an average of 21 hours of hospital physicians’ time over the course of a month. The study suggests that the application of DSM can improve the usability of an EMR user interface.

References

Healthcare Information and Management Systems Society, “Defining and testing EMR usability: principles and proposed methods of EMR usability evaluation and rating,” 2009, http://www.himss.org/files/HIMSSorg/content/files/HIMSS_DefiningandTestingEMRUsability.pdf, Accessed Feb 25, 2013.
View at: Google Scholar
J. B. Smelcer, H. Jacobs-Miller, and L. Kantrovich, “Usability of electronic medical records,” Journal of Usability Studies, vol. 4, no. 2, pp. 70–84, 2009.
View at: Google Scholar
P. Sengstack, “CPOE configuration to reduce medication errors: a literature review on the safety of CPOE systems and design recommendations,” The Journal of Healthcare Information Management, vol. 24, no. 4, pp. 26–34, 2010.
View at: Google Scholar
International Organization for Standardization, ISO 9241-11: Ergonomic requirements for office work with visual display terminals (VDTs) - Guidance on usability. 1998, http://www.it.uu.se/edu/course/homepage/acsd/vt09/ISO9241part11.pdf.
E. Jamoom, M. S. Beatty, A. Bercovitz, D. Woodwell, and K. Palso, Rechtsteiner, E. Physician Adoption of Electronic Health Record Systems: United States, 2011, NCHS data brief, no 98, National Center for Health Statistics, Hyattsville, MD, 2012.
J. C. Pham, M. S. Aswani, M. Rosen et al., “Reducing medical errors and adverse events,” Annual Review of Medicine, vol. 63, pp. 447–463, 2012.
View at: Google Scholar
R. Koppel, J. P. Metlay, A. Cohen et al., “Role of computerized physician order entry systems in facilitating medication errors,” The Journal of the American Medical Association, vol. 293, no. 10, pp. 1197–1203, 2005.
View at: Google Scholar
K. E. Walsh, W. G. Adams, H. Bauchner et al., “Medication errors related to computerized order entry for children,” Pediatrics, vol. 118, no. 5, pp. 1872–1879, 2006.
View at: Google Scholar
J. Nielsen, Usability Engineering, Academic Press, San Diego, CA, 1993.
Department of Health and Human Services, Digital Communications Division. Page Layout. http://www.usability.gov/pdfs/chapter6.pdf, Accessed Feb 10, 2013.
T. Halverson and A. J. Hornof, “Local density guides visual search: sparse groups are first and faster,” in Conf Proc of Human Factors and Ergonomics Society, pp. 1–5, 2004.
View at: Google Scholar
T. S. Tullis, “The formatting of alphanumeric displays: a review and analysis,” Human Factors, vol. 25, no. 6, pp. 657–682, 1983.
View at: Google Scholar
A. W. Kushniruk and V. L. Patel, “Cognitive and usability engineering methods for the evaluation of clinical information systems,” Journal of Biomedical Informatics, pp. 37–56, 2004.
View at: Google Scholar
Y. Liu, A. L. Osvalder, and S. Dahlman, “Exploring user background settings in cognitive walkthrough evaluation of medical prototype interfaces: a case study,” International Journal of Industrial Ergonomics, vol. 35, pp. 379–390, 2005.
View at: Google Scholar
C. Wharton, J. Rieman, C. Lewis, and P. Polson, “The cognitive walkthrough method: A practitioner's guide,” in Usability Inspection Methods, J. Nielsen and R. L. Mack, Eds., pp. 106–139, John Wiley & Sons, New York, NY, 1994.
View at: Google Scholar
M. Hertzum and N. E. Jacobsen, “The evaluator effect: a chilling fact about usability evaluation methods,” International Journal of Human-Computer Interaction, vol. 15, no. 1, pp. 183–204, 2003.
View at: Google Scholar
A. Sears and D. J. Hess, “Cognitive walkthroughs: Understanding the effect of task-description detail on evaluator performance,” International Journal of Human-Computer Interaction, vol. 11, no. 3, pp. 185–200, 1999.
View at: Google Scholar
T. Tullis and B. Albert, Measuring the User Experience, Morgan Kaufman, Burlington, MA, 2008.
S. K. Card, T. P. Moran, and A. Newell, “The keystroke-level model for user performance time with interactive systems,” Communications of the ACM, vol. 23, no. 7, pp. 396–410, 1980.
View at: Google Scholar
L. Teo, B. E. John, and M. H. Blackmon, “CogTool explorer: a model of goal-directed user exploration that considers information layout,” in Conf Proc of Human Factors in Computing Systems, pp. 2479–2488, 2012.
View at: Google Scholar
B. E. John and B. S. Utesch, “Experiences with collaborative, distributed predictive human performance modeling,” in Conf Proc of Human Factors in Computing Systems, pp. 437–452, 2012.
View at: Google Scholar
R. Bellamy, B. E. John, J. Richards, and J. Thomas, “Using CogTool to model programming tasks,” in Conf Proc of Evaluation and Usability of Programming Languages and Tools, pp. 1–6, 2010.
View at: Google Scholar
B. E. John, K. Prevas, D. D. Salvucci, and K. Koedinger, “Predictive human performance made easy,” in Conf Proc of Human Factors in Computing Systems, pp. 455–462, 2004.
View at: Google Scholar
P. M. Fitts, “The information capacity of the human motor system in controlling the amplitude of movement,” Journal of Experimental Psychology, vol. 47, pp. 381–391, 1954.
View at: Google Scholar
S. E. Hudson, B. E. John, K. Knudsen, and M. D. Byrne, “A tool for creating predictive performance models from user interface demonstrations,” in Conf Proc of the ACM Symposium on User Interface and Technology, pp. 93–102, 1999.
View at: Google Scholar
Department of Health and Human Services, Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition, Final Rule. (2012)http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/html/2012-4430.htm.
S. Z. Lowry and R. M. Schumacher, “NIST guide to the process approach for improving the usability of electronic health records,” NIST Interagency/Internal Report (NISTIR) – 7741, 2010.
View at: Google Scholar
C. M. Johnson, T. R. Johnson, and J. Zhang, “A user-centered framework for redesigning healthcare interfaces,” Journal of Biomedical Informatics, vol. 38, pp. 75–87, 2005.
View at: Google Scholar
S. D. Eppinger and T. R. Browning, Design Structure Matrix Methods and Applications, MIT Press, Cambridge, MA, 2012.
D. V. Steward, “The design structure system: a method for managing the design of complex systems,” IEEE Transactions on Engineering Management, vol. 28, no. 3, pp. 71–74, 1981.
View at: Google Scholar
T. R. Browning, “Applying the design structure matrix to system decomposition and integration problems: a review and new directions,” IEEE Transactions on Engineering Management, vol. 48, no. 3, pp. 292–306, 2001.
View at: Google Scholar
A. Yassine and D. Braha, “Complex concurrent engineering and the design structure matrix method,” Concurrent Engineering: Research and Applications, vol. 11, no. 3, pp. 165–176, 2003.
View at: Google Scholar
M. Danilovic, “Bring your suppliers into your projects – Managing the design of work packages in product development,” Journal of Purchasing & Supply Management, vol. 12, pp. 246–257, 2006.
View at: Google Scholar
E. S. Suh and O. Weck, “Xerox digital printing technology infusion,” in Design Structure Matrix Methods and Applications, S. D. Eppinger and T. R. Browning, Eds., pp. 43–48, MIT Press, Cambridge, MA, 2012.
View at: Google Scholar
J. Nielsen, “Heuristic evaluation,” in Usability Inspection Methods, J. Nielsen and R. L. Mack, Eds., pp. 25–61, John Wiley & Sons, New York, NY, 1994.
View at: Google Scholar
D. C. Wynn, D. F. Wyatt, S. M. T. Nair, and P. J. Clarkson, “An introduction to the Cambridge advanced modeler,” in Conf Proc of the International Conference on Modelling and Management of Engineering Processes, pp. 1–4, 2010.
View at: Google Scholar
M. C. Lovett, L. M. Reder, and C. Lebiere, “Modeling working memory in a unified architecture: an ACT-R perspective,” in Models of Working Memory, A. Miyake and P. Shah, Eds., pp. 135–182, Cambridge University Press, New York, NY, 1999.
View at: Google Scholar
R. Hillestad, J. Bigelow, A. Bower et al., “Can electronic medical record systems transform health care? Potential health benefits, savings, and costs,” Health Affairs, vol. 24, no. 2, pp. 1103–1117, 2005.
View at: Google Scholar
B. Kaplan and K. D. Harris-Salamone, “Health IT success and failure: Recommendations from literature and an AMIAWorkshop,” Journal of the American Medical Informatics Association, vol. 16, pp. 291–299, 2009.
View at: Google Scholar
S. I. MacKenzie, “Fitts' law as a research and design tool in human-computer interaction,” Human-Computer Interaction, vol. 7, pp. 91–139, 1992.
View at: Google Scholar
S. C. Seow, “Information theoretic models of HCI: a comparison of the Hick-Hyman law and Fitts' law,” Human-Computer Interaction, vol. 20, pp. 315–352, 2005.
View at: Google Scholar
W. Ding and X. Lin, Information Architecture: the Design and Integration of Information Spaces, Morgan Claypool, 2009.
K. Kuqi, T. Eveleigh, T. Holzer, and S. Sarkani, “Using design structure matrix for improving electronic medical record usability,” in Conf Proc of IEEE International Systems Conference, pp. 1–6, 2012.
View at: Google Scholar
W. O. Galitz, The Essential Guide To User Interface Design: An Introduction To GUI Design Principles and Techniques, John Wiley & Sons, Canada, 2nd edition, 2002.
L. L. Constantine and L. A. Lockwood, Software for User: A Practical Guide to the Models and Methods of Usage-Centered Design, Addison Wesley, Reading, MA, 1999.

Copyright

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation Order printed copies

Views

1425

Downloads

3197

Citations