Borycki E, Kushniruk A, Nohr C, Takeda H, Kuwata S, Carvalho C, Bainbridge M, Kannry J
School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada. E-mail:
Yearb Med Inform. 2013;8:20-7.
Issues related to lack of system usability and potential safety hazards continue to be reported in the health information technology (HIT) literature. Usability engineering methods are increasingly used to ensure improved system usability and they are also beginning to be applied more widely for ensuring the safety of HIT applications. These methods are being used in the design and implementation of many HIT systems. In this paper we describe evidence-based approaches to applying usability engineering methods.
A multi-phased approach to ensuring system usability and safety in healthcare is described. Usability inspection methods are first described including the development of evidence-based safety heuristics for HIT. Laboratory-based usability testing is then conducted under artificial conditions to test if a system has any base level usability problems that need to be corrected. Usability problems that are detected are corrected and then a new phase is initiated where the system is tested under more realistic conditions using clinical simulations. This phase may involve testing the system with simulated patients. Finally, an additional phase may be conducted, involving a naturalistic study of system use under real-world clinical conditions.
The methods described have been employed in the analysis of the usability and safety of a wide range of HIT applications, including electronic health record systems, decision support systems and consumer health applications. It has been found that at least usability inspection and usability testing should be applied prior to the widespread release of HIT. However, wherever possible, additional layers of testing involving clinical simulations and a naturalistic evaluation will likely detect usability and safety issues that may not otherwise be detected prior to widespread system release.
The framework presented in the paper can be applied in order to develop more usable and safer HIT, based on multiple layers of evidence.
健康信息技术（HIT）文献中持续报道了与系统可用性不足和潜在安全隐患相关的问题。可用性工程方法越来越多地用于确保系统可用性得到改善，并且它们也开始更广泛地应用于确保HIT应用程序的安全性。这些方法正被用于许多HIT系统的设计和实施中。在本文中，我们描述了应用可用性工程方法的循证方法。
描述了一种在医疗保健中确保系统可用性和安全性的多阶段方法。首先介绍了可用性检查方法，包括为HIT开发基于证据的安全启发式方法。然后在人工条件下进行基于实验室的可用性测试，以测试系统是否存在任何需要纠正的基本可用性问题。对检测到的可用性问题进行纠正，然后启动一个新阶段，在更现实的条件下使用临床模拟对系统进行测试。此阶段可能涉及对模拟患者进行系统测试。最后，可能会进行一个额外的阶段，包括在实际临床条件下对系统使用情况进行自然主义研究。
所描述的方法已用于分析各种HIT应用程序的可用性和安全性，包括电子健康记录系统、决策支持系统和消费者健康应用程序。已发现至少应在HIT广泛发布之前应用可用性检查和可用性测试。然而，只要有可能，涉及临床模拟和自然主义评估的额外测试层可能会检测到在系统广泛发布之前可能无法检测到的可用性和安全问题。
本文提出的框架可用于开发基于多层证据的更可用、更安全的HIT。
