Development and evaluation of a novel user interface for reviewing clinical microbiology results

Abstract Background Microbiology laboratory results are complex and cumbersome to review. We sought to develop a new review tool to improve the ease and accuracy of microbiology results review. Methods We observed and informally interviewed clinicians to determine areas in which existing microbiology review tools were lacking. We developed a new tool that reorganizes microbiology results by time and organism. We conducted a scenario-based usability evaluation to compare the new tool to existing legacy tools, using a balanced block design. Results The average time-on-task decreased from 45.3 min for the legacy tools to 27.1 min for the new tool (P < .0001). Total errors decreased from 41 with the legacy tools to 19 with the new tool (P = .0068). The average Single Ease Question score was 5.65 (out of 7) for the new tool, compared to 3.78 for the legacy tools (P < .0001). The new tool scored 88 (“Excellent”) on the System Usability Scale. Conclusions The new tool substantially improved efficiency, accuracy, and usability. It was subsequently integrated into the electronic health record and rolled out system-wide. This project provides an example of how clinical and informatics teams can innovative alongside a commercial Electronic Health Record (EHR).

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User Evaluation of the Swedish Patient Accessible Electronic Health Record: System Usability Scale (Preprint)

JMIR Human Factors ◽

10.2196/24927 ◽

2020 ◽

Author(s):

Maria Hägglund ◽

Isabella Scandurra

Keyword(s):

Electronic Health Record ◽

Electronic Health Record System ◽

Health Record ◽

User Evaluation ◽

Record System ◽

System Usability Scale ◽

System Usability ◽

Electronic Health ◽

Swedish Patient

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User Evaluation of the Swedish Patient Accessible Electronic Health Record: System Usability Scale (Preprint)

10.2196/preprints.24927 ◽

2020 ◽

Author(s):

Maria Hägglund ◽

Isabella Scandurra

Keyword(s):

Electronic Health Record ◽

Ease Of Use ◽

Survey Study ◽

Health Record ◽

Patient Portal ◽

Data Set ◽

System Usability Scale ◽

System Usability ◽

National Patient ◽

Electronic Health

BACKGROUND Transparency is increasingly called for in health care, especially, when it comes to patients’ access to their electronic health records. In Sweden, the e-service Journalen is a national patient accessible electronic health record (PAEHR), accessible online via the national patient portal. User characteristics and perceived benefits of using a PAEHR influence behavioral intention for use and adoption, but poor usability that increases the effort expectancy can have a negative impact. It is, therefore, of interest to explore how users of the PAEHR Journalen perceive its usability and usefulness. OBJECTIVE The aim of this study was to explore how the users of the Swedish PAEHR experience the usability of the system and to identify differences in these experiences based on the level of transparency of the region. METHODS A survey study was conducted to elicit opinions and experiences of patients using Journalen. The data were collected from June to October 2016. The questionnaire included questions regarding the usability of the system from the System Usability Scale (SUS). The SUS analysis was the focus of this paper. Analysis was performed on different levels: nationally looking at the whole data set and breaking it down by focusing on 2 different regions to explore differences in experienced usability based on the level of transparency. RESULTS During the survey period, 423,141 users logged into Journalen, of which 2587 unique users completed the survey (response rate 0.61%). The total mean score for all respondents to the SUS items was 79.81 (SD 14.25), which corresponds to a system with good usability. To further explore whether the level of transparency in a region would affect the user’s experience of the usability of the system, we analyzed the 2 regions with the most respondents: Region Uppsala (the first to launch, with a high level of transparency), and Region Skåne (an early implementer, with a low level of transparency at the time of the survey). Of the participants who responded to at least 1 SUS statement, 520 stated that they had received care in Region Skåne, whereas 331 participants had received care in Region Uppsala. Uppsala’s mean SUS score was 80.71 (SD 13.41), compared with Skåne’s mean of 79.37 (SD 13.78). CONCLUSIONS The Swedish national PAEHR Journalen has a reasonably good usability (mean SUS score 79.81, SD 14.25); however, further research into more specific usability areas are needed to ensure usefulness and ease of use in the future. A somewhat higher SUS score for the region with high transparency compared with the region with low transparency could indicate a relationship between the perceived usability of a PAEHR and the level of transparency offered, but further research on the relationship between transparency and usability is required.

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Using HL7 CDA and LOINC for standardized laboratory results in the Austrian electronic health record

LaboratoriumsMedizin ◽

10.1515/labmed-2018-0105 ◽

2018 ◽

Vol 42 (6) ◽

pp. 259-266

Author(s):

Stefan Sabutsch ◽

Gerhard Weigl

Keyword(s):

Electronic Health Record ◽

Health Record ◽

Laboratory Results ◽

Electronic Health ◽

First Time

AbstractWith the implementation of the Austrian electronic health record (ELGA), laboratory results are formally standardized for the first time throughout Austria. The nomenclature of the lab analyses, their sequence and structure as well as the display of laboratory results are unified with ELGA. One of the most significant steps is using Logical Observation Identifiers Names and Codes (LOINC) as a reference terminology for lab analyses. Thereby laboratory results can be reused semantically interoperable all over Austria.

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Higher costs and utilization occurs among patients with diabetes mellitus when HbA1c results are not present in the electronic health record: a retrospective analysis (Preprint)

10.2196/preprints.35355 ◽

2021 ◽

Author(s):

Kimberly Anne Gudzune ◽

Klaus Lemke ◽

Anne K. Monroe ◽

Jonathan P. Weiner

Keyword(s):

Diabetes Mellitus ◽

Emergency Department ◽

Risk Stratification ◽

Electronic Health Record ◽

Information Exchange ◽

Healthcare Costs ◽

Population Level ◽

Health Record ◽

Laboratory Results ◽

Electronic Health

BACKGROUND Clinical information may frequently be missing from the electronic health record (EHR), and contributes to delayed care, adverse events, and additional services, which may be costly. Missing laboratory data might be valuable marker for population-level risk stratification to help identify patients at risk of high cost and utilization. OBJECTIVE To determine whether absent hemoglobin HbA1c results in the EHR stratifies risk of high healthcare costs and utilization among adults with diabetes mellitus (DM). METHODS Retrospective U.S. cohort with EHR and claims data (2012-2013) of 6,270 continuously insured and care-engaged patients with DM who had ≥1 ambulatory visit in 2012. HbA1c availability defined as “HbA1c present” if ≥1 HbA1c EHR result was available in 2012 and otherwise as “HbA1c absent.” Patient’s annual healthcare costs, presence of any inpatient hospitalization, and presence of any emergency department (ED) visit in 2012 (concurrent) and 2013 (prospective).We used linear and logistic regression analyses, adjusting for age, gender and comorbidity, to determine associations with concurrent and prospective healthcare costs, emergency department (ED) visit, and hospitalization. RESULTS Overall, HbA1c result was absent from the EHR in 20.2%. Absent HbA1c status had significantly greater healthcare costs than HbA1c present (Concurrent difference: $5,081, p<0.001; Prospective difference: $5,489, p<0.001). Absent HbA1c status was significantly more likely to have an ED visit than HbA1c present (Concurrent: OR 1.44, p<0.001; Prospective: OR 1.29, p=0.01). No significant differences in hospitalization existed between groups. CONCLUSIONS Markers indicating absent laboratory results in the EHR, such as HbA1c availability, may be a promising population-level risk stratification approach. HbA1c availability appears to offer clinically relevant information associated with high healthcare costs and utilization. Future research might use markers identifying HbA1c or other laboratory results absent from the EHR to trigger various quality improvement interventions, such as health information exchange, clinical decision support, or care management.

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Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis

Journal of Medical Internet Research ◽

10.2196/23382 ◽

2020 ◽

Vol 22 (12) ◽

pp. e23382

Author(s):

Edward R Melnick ◽

Elizabeth Harry ◽

Christine A Sinsky ◽

Liselotte N Dyrbye ◽

Hanhan Wang ◽

...

Keyword(s):

Electronic Health Record ◽

Mediation Analysis ◽

National Level ◽

Maslach Burnout Inventory ◽

Medical Decision ◽

Health Record ◽

Professional Burnout ◽

Task Load ◽

System Usability Scale ◽

Electronic Health

Background Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task load. Objective This study aimed to determine the relationship between physician-perceived EHR usability and workload by specialty and evaluate for associations with professional burnout. Methods A secondary analysis of a cross-sectional survey of US physicians from all specialties was conducted from October 2017 to March 2018. Among the 1250 physicians invited to respond to the subsurvey analyzed here, 848 (67.8%) completed it. EHR usability was assessed with the System Usability Scale (SUS; range: 0-100). Provider task load (PTL) was assessed using the mental demand, physical demand, temporal demand, and effort required subscales of the National Aeronautics and Space Administration Task Load Index (range: 0-400). Burnout was measured using the Maslach Burnout Inventory. Results The mean scores were 46.1 (SD 22.1) for SUS and 262.5 (SD 71.7) for PTL. On multivariable analysis adjusting for age, gender, relationship status, medical specialty, practice setting, hours worked per week, and number of nights on call per week, physician-rated EHR usability was associated with PTL, with each 1-point increase in SUS score (indicating more favorable) associated with a 0.57-point decrease in PTL score (P<.001). On mediation analysis, higher SUS score was associated with lower PTL score, which was associated with lower odds of burnout. Conclusions A strong association was observed between EHR usability and workload among US physicians, with more favorable usability associated with less workload. Both outcomes were associated with the odds of burnout, with task load acting as a mediator between EHR usability and burnout. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision making and patient communication.

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Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis (Preprint)

10.2196/preprints.23382 ◽

2020 ◽

Author(s):

Edward R Melnick ◽

Elizabeth Harry ◽

Christine A Sinsky ◽

Liselotte N Dyrbye ◽

Hanhan Wang ◽

...

Keyword(s):

Electronic Health Record ◽

Mediation Analysis ◽

National Level ◽

Maslach Burnout Inventory ◽

Medical Decision ◽

Health Record ◽

Professional Burnout ◽

Task Load ◽

System Usability Scale ◽

Electronic Health

BACKGROUND Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task load. OBJECTIVE This study aimed to determine the relationship between physician-perceived EHR usability and workload by specialty and evaluate for associations with professional burnout. METHODS A secondary analysis of a cross-sectional survey of US physicians from all specialties was conducted from October 2017 to March 2018. Among the 1250 physicians invited to respond to the subsurvey analyzed here, 848 (67.8%) completed it. EHR usability was assessed with the System Usability Scale (SUS; range: 0-100). Provider task load (PTL) was assessed using the mental demand, physical demand, temporal demand, and effort required subscales of the National Aeronautics and Space Administration Task Load Index (range: 0-400). Burnout was measured using the Maslach Burnout Inventory. RESULTS The mean scores were 46.1 (SD 22.1) for SUS and 262.5 (SD 71.7) for PTL. On multivariable analysis adjusting for age, gender, relationship status, medical specialty, practice setting, hours worked per week, and number of nights on call per week, physician-rated EHR usability was associated with PTL, with each 1-point increase in SUS score (indicating more favorable) associated with a 0.57-point decrease in PTL score (<i>P</i><.001). On mediation analysis, higher SUS score was associated with lower PTL score, which was associated with lower odds of burnout. CONCLUSIONS A strong association was observed between EHR usability and workload among US physicians, with more favorable usability associated with less workload. Both outcomes were associated with the odds of burnout, with task load acting as a mediator between EHR usability and burnout. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision making and patient communication.

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Business: The Electronic Health Record: Front Line Experience

Perspectives on Administration and Supervision ◽

10.1044/aas21.1.18 ◽

2011 ◽

Vol 21 (1) ◽

pp. 18-22

Author(s):

Rosemary Griffin

Keyword(s):

Health Care ◽

Information Technology ◽

Electronic Health Record ◽

Financial Incentives ◽

Best Practice ◽

Health Care Systems ◽

The United States ◽

Health Record ◽

Health Trends ◽

Electronic Health

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.

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