Press Anne, DeStio Catherine, McCullagh Lauren, Kapoor Sandeep, Morley Jeanne, Conigliaro Joseph
Hofstra Northwell School of Medicine, Manhasset, NY, United States.
JMIR Hum Factors. 2016 Jul 8;3(2):e18. doi: 10.2196/humanfactors.5820.
Screening, brief intervention, and referral to treatment (SBIRT) is currently being implemented into health systems nationally via paper and electronic methods.
The purpose of this study was to evaluate the integration of an electronic SBIRT tool into an existing paper-based SBIRT clinical workflow in a patient-centered medical home.
Usability testing was conducted in an academic ambulatory clinic. Two rounds of usability testing were done with medical office assistants (MOAs) using a paper and electronic version of the SBIRT tool, with two and four participants, respectively. Qualitative and quantitative data was analyzed to determine the impact of both tools on clinical workflow. A second round of usability testing was done with the revised electronic version and compared with the first version.
Personal workflow barriers cited in the first round of testing were that the electronic health record (EHR) tool was disruptive to patient's visits. In Round 2 of testing, MOAs reported favoring the electronic version due to improved layout and the inclusion of an alert system embedded in the EHR. For example, using the system usability scale (SUS), MOAs reported a grade "1" for the statement, "I would like to use this system frequently" during the first round of testing but a "5" during the second round of analysis.
The importance of testing usability of various mediums of tools used in health care screening is highlighted by the findings of this study. In the first round of testing, the electronic tool was reported as less user friendly, being difficult to navigate, and time consuming. Many issues faced in the first generation of the tool were improved in the second generation after usability was evaluated. This study demonstrates how usability testing of an electronic SBRIT tool can help to identify challenges that can impact clinical workflow. However, a limitation of this study was the small sample size of MOAs that participated. The results may have been biased to Northwell Health workers' perceptions of the SBIRT tool and their specific clinical workflow.
目前，筛查、简短干预和转诊治疗（SBIRT）正通过纸质和电子方式在全国范围内纳入卫生系统。
本研究的目的是评估将电子SBIRT工具整合到以患者为中心的医疗家庭中现有的基于纸质的SBIRT临床工作流程中的情况。
在一家学术门诊诊所进行了可用性测试。使用SBIRT工具的纸质版和电子版对医疗办公室助理（MOA）进行了两轮可用性测试，第一轮分别有两名参与者，第二轮有四名参与者。对定性和定量数据进行了分析，以确定两种工具对临床工作流程的影响。对修订后的电子版进行了第二轮可用性测试，并与第一个版本进行了比较。
第一轮测试中提到的个人工作流程障碍是电子健康记录（EHR）工具干扰了患者就诊。在第二轮测试中，医疗办公室助理报告称，由于布局改进以及电子健康记录中嵌入了警报系统，他们更喜欢电子版。例如，使用系统可用性量表（SUS），医疗办公室助理在第一轮测试中对“我想经常使用这个系统”这一陈述给出了“1”分，但在第二轮分析中给出了“5”分。
本研究结果突出了测试医疗保健筛查中使用的各种工具媒介可用性的重要性。在第一轮测试中，电子工具被报告为不太用户友好，难以操作且耗时。在评估可用性后，第一代工具面临的许多问题在第二代中得到了改进。本研究展示了电子SBRIT工具的可用性测试如何有助于识别可能影响临床工作流程的挑战。然而，本研究的一个局限性是参与的医疗办公室助理样本量较小。结果可能偏向于诺斯韦尔健康中心工作人员对SBIRT工具及其特定临床工作流程的看法。
