Exploring the relationship between usability and technology-induced error: unraveling a complex interaction.

The effective evaluation of the usability of health information systems is currently a major challenge. It is essential that the applications we develop are not only usable, but that they are also shown to be safe and do not inadvertently introduce errors. Furthermore, to provide appropriate feedback to designers of systems new methods for evaluation are needed as applications become more complex and distributed. To ensure system usability and safety a variety of methods have emerged from the area of usability engineering that have been adapted to healthcare. The authors have applied and adapted methods of usability engineering, working with hospitals and other healthcare organizations for designing and evaluating a range of health information systems over a number of years. We describe a methodological framework for considering some of these advances and show how a range of usability evaluations can be used to evaluate both the usability and safety of healthcare information systems both in artificial mocked up and real clinical settings using in-situ testing approaches. We conclude with a discussion of recent trends in the area of usability engineering in healthcare that have potential for improving the safety of healthcare information systems.