Based upon the issues identified in the Elrod and Androwich.

Based upon the issues identified in the Elrod and Androwich… Based upon the issues identified in the Elrod and Androwich article, recommend at least health IT devices related to EHRs that contain human design elements that support user acceptance.Explain how these elements enhance the likelihood of user acceptance. Applying Human Factors Analysis to the Design of the Electronic Health Record Jenny ELRODa and Ida M. ANDROWICHb a Advocate Good Shepherd Hospital, Barrington, ,IL,USA b Niehoff School of Nursing, Loyola University Chicago, IL, USA Abstract: The healthcare industry is automating clinical documentation at the point of care— taking us from paper documentation to an electronic health record (EHR). Designing user-friendly, intuitive systems is challenging, and has motivated hospitals to evaluate and adopt new and safer practices to help reduce the contribution that technology plays in healthcare error. To accomplish this, healthcare is evaluating how other industries, like aviation, have successfully applied human factors to system design. Recent healthcare research has demonstrated the potential value of human factors in information technology (IT) projects. This article provides a synthesis of research on the application of human factors to the design and development of the electronic health record and makes apparent the need for human factors education for nurses and IT professionals involved in EHR design. Keywords: human factors, human error, EHR, patient safety, system design, user centered design, interface design, usability Introduction Technology has created a highly specialized environment both inside and outside of the hospital1 . Nurses use many different forms of technology such as intravenous (IV) pumps and physiologic monitors, but technology also comes in the form of computer applications that have taken us from paper documentation to an electronic health record (EHR). It is not uncommon to walk into a patient room and see a computer at the bedside or a computer on a cart that a nurse moves from room to room. Nurses are not only end-users of the system documenting patient care, but many are advancing into informatics roles to be involved in the design and development of the EHR. The nurse informatician (NI) leverages his/her clinical experience to synthesize the needs of end users and then uses that knowledge to design systems that facilitate data entry, viewing and interpretation of patient data.2 One EHR design method receiving increased attention is human factors. Healthcare is now evaluating how other industries, like aviation, have used human factors analysis to successfully reduce error.3 In the last century, aviation has made tremendous strides reducing accident rates and achieving unprecedented levels of safety.4 Due to the high-risk systems in aviation, it is not advantageous to wait for a plane to crash before analyzing detailed information about a systems design, Connecting Health and Humans K. Saranto et al. (Eds.) IOS Press, 2009 © 2009 The authors and IOS Press. All rights reserved. doi:10.3233/978-1-60750-024-7-132 132 performance and safety risk.5 The same applies to healthcare information technology and specifically the EHR. It is important that nurses and other clinicians involved in system design use the process of human factors to build and strengthen their focus on patient safety.6 We do not want to discover that nurses spend so much time navigating screens and entering patient data in the computer that they miss providing an essential treatment or other patient care. The amount of data that nurses must chart to construct a patient assessment is voluminous, and when too many parameters exist without clear delineation of critical data, decision making can be impeded.2 Objectives This article provides a synthesis of research on the application of human factors to the design and development of the electronic health record. The purpose is threefold: 1) to define human factors and the concepts of human error, usability and user centered design 2) to identify the role of the nurse informaticist in patient safety initiatives related to IT and 3) to examine existing research using human factors and explain its’ importance to EHR design and development. Human factors analysis is the scientific study of how humans and machines interact in their work environment.2 Human factors is often considered synonymous with the terms human factors theory, human factors engineering, ergonomics, usability engineering and engineering psychology.7 The aviation industry has successfully reduced error using human factors to design safer, smarter systems that anticipate and expect human error. Because the complexities of the healthcare environment are similar to aviation, the application of human factors to systems design is a logical next step.8 For example, the operating room is very similar to an aircraft cockpit where multiple tasks must be accomplished and monitored with precision. Although many of the initial studies with human factors in healthcare were focused on the complex anesthesia environment (similar to that of the airline cockpit), healthcare has endorsed more widespread application of human factors to the design of the EHR. When discussing the application of human factors to EHR design it is essential to provide some working definitions of the concepts of human error, usability and user centered design.8 The study of human factors revolves around the basic premise that humans are fallible and errors are predictable.9 This is not the traditional view of errors in healthcare. The Australian Council for Safety and Quality Health Care10 refers to the present day view of human error in healthcare as the “perfectibility model.” This includes the belief that if clinicians work hard enough, are sufficiently trained, and care for their patients to the best of their ability, errors will be avoided. According to Reason9 , errors can be viewed in two ways; the person approach and the system approach. The person approach focuses on an individual’s error and will often point fingers and assume that wrong-doing is the sole responsibility of the individual. In contrast, the system approach considers multiple contributions to error, including an individual’s working environment, and attempts to build complex systems that can avoid errors and/or compensate for them.9 This is how aviation views error. The system approach recognizes that errors will occur, but attempts to mitigate risk with technology systems that manage and reduce it. Errors associated with imperfect processing of data and J. Elrod and I.M. Androwich / Applying Human Factors Analysis to the Design of the EHR 133 flawed decision making may also occur, and can be overcome by using human factors in designing smarter, safer systems.11 Usability has been defined as the effectiveness, efficiency and satisfaction with which specific users can accomplish tasks in a particular environment12 The term user centered design (UCD) was first proposed in 1986 by Norman and Draper and involves multiple different approaches to system design.15 As a result of the varying approaches, there is no agreed upon definition for UCD.16 UCD requires clearly identifying user needs and characteristics in order to assure that the system is designed for its’ intended purpose, and will operate in a manner consistent with the workflow of the user.6 UCD is an iterative process repeated multiple times throughout the design cycle to identify deficiencies and promote design refinement before reaching the end user in a patient care environment.6 The application of human factors concepts should begin with the vendor developing the software and be carried forward when configuring systems in the hospital environment. Nurses as caregivers assemble the ‘patient story’ by accurately recording, interpreting and acting on patient data in the EHR.17 NIs help others to understand workflow and design and configure the EHR to support documentation for direct caregivers. Collaboration between clinical (informaticist) and technical (IT) resources is critical to the success of a system design. The nurse informaticist draws on his/her clinical experience to help identify, design, build and test software that will increase efficiency and productivity, and with the intent to reduce medical error. Nurse informaticists can use human factors and the concept of usability to design safer; more user friendly systems that promote not hinder workflow.13 Recently, regulatory agencies in the US have advocated for a reduction in health care error by using information technology. One example is the National Patient Safety Goals (NPSG’s) from The Joint Commission. The NPSG’s were developed to promote specific improvements in patient safety and a foster change in information technology.24 One example is NPSG 3 that focuses on medication safety. Computerized provider order entry (CPOE) and look-alike, sound-alike drugs pose an opportunity for system error, and organizations must consider the cause of error and the impact of drug names when designing their system. By anticipating errors around drug selection, systems can be designed to avoid display of similar drugs consecutively in lists to avoid picking errors. Computerized alerts and reminders can be developed for specific drugs to notify prescribers of problems/conflicts during the prescribing process. The concept of usability in the field of human factors can be employed to develop EHR systems that are user friendly, efficient, and have tested user interfaces that promote usability.13 Nemeth et al. identified the need to design systems for the sharp end (i.e. the operator or user) of healthcare28 and propose that understanding both cognitive work and clinical practice would provide a foundation in understanding how IT supports clinical practice. In many system design projects, failures are not as a result of the technology used, but are due to the lack of consideration of the end users during the design process.29 Embracing the concept of user-centered design is beneficial to promote user satisfaction and adoption of IT. Johnson, Johnson and Zhang (2005) developed a framework for guiding the redesign process of a system.30. 134 J. Elrod and I.M. Androwich / Applying Human Factors Analysis to the Design of the EHR Another important concept of human factors is user centered design (UCD) which can be applied in various ways to the design of EHR systems. Ju & Gluck (2004) reorganized and re-labeled a software menu interface. The researchers employed a UCD approach called user process modeling, to provide essential data on the usability of their system. The study was based on a comparison between two menu versions; a newly designed menu and the original menu based on a categorical menu structure. The goals were to assess user satisfaction, efficiency and effectiveness between the menu versions. Usability testing results in the study showed that the new and original menu versions were similarly effective from the standpoint of time, accuracy and task completion, but were dependent on task type—with some showing favorable results toward the new version. The authors identified the need to use a deeper human ontological point of view in interface design. The application of human factors to medical devices is highly pertinent and not limited to IT alone. In 2004 Fairbanks and Caplan conducted a usability study of defibrillators by having paramedics perform four tasks and exercise functions of two defibrillators with different user interfaces. 13 Analysis of the study data showed multiple deficiencies in the user interface (e.g. too many buttons on the screen) design that contributed to poor ease-of-use.13 Poor user interface can result in inefficient care and cause redundancy or missing information that is important for making patient care decisions.30 Discussion and Conclusions User satisfaction and the adoption of information technology are often related to a system’s usability.12 As a result, the application of human factors is becoming a more widely recognized tool to develop solutions that improve usability for the clinicians who use technology and document patient care. In 2004, Karsh identified that “…design does not end once usability and usefulness are addressed” (p. 388).14 A synthesis of existing healthcare research demonstrates the different approaches taken to design and re-design EHR systems using human factors. Many systems initially identified to reduce errors have been abandoned because of flawed designs and negative impact on workflow and user dissatisfaction.14 Healthcare providers must consider widespread education in human factors for nurses and IT professionals involved in EHR design. Improved understanding of human factors concepts is one method to support better understanding of the human components that are essential, but not often considered, in system design. Current deadlines tend to drive development, but time spent using human factors concepts to improve usability and focus on user-centered design, has the potential to improve project success and prevent errors. References 1. Wachter R. The end of the beginning: patient safety five years after to err is human. Health Affairs. 200Health Science Science Nursing HIM 470

Let the Experts Do Your Homework Now



Do you have a similar question? Our professional writers have done a similar paper in past.
Give Us your instructions and wait for a professional assignment!

Get a plagiarism-free order today

we guarantee confidentiality and a professional paper and we will meet the deadline.

How it works

  • Paste your instructions in the instructions box. You can also attach an instructions file
  • Select the writer category, deadline, and education level and review the instructions
  • Make a payment for the order to be assigned to a writer
  • Download the paper after the writer uploads it

  • Will the writer plagiarize my essay?
    You will get a plagiarism-free paper and you can get an originality report upon request.

    Is this service safe?
    All personal information is confidential and we have 100% safe payment methods. We also guarantee good grades