Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Missouri, United States.
Pediatric Hospital Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States.
Appl Clin Inform. 2019 Mar;10(2):210-218. doi: 10.1055/s-0039-1681073. Epub 2019 Mar 27.
Usability of electronic health records (EHRs) remains challenging, and poor EHR design has patient safety implications. Heuristic evaluation detects usability issues that can be classified by severity. The National Institute of Standards and Technology provides a safety scale for EHR usability. Our objectives were to investigate the relationship between heuristic severity ratings and safety scale ratings in an effort to analyze EHR safety.
Heuristic evaluation was conducted on seven common mobile EHR tasks, revealing 58 heuristic violations and 28 unique usability issues. Each usability issue was independently scored for severity by trained hospitalists and a Human Factors researcher and for safety severity by two physician informaticists and two clinical safety professionals.
Results demonstrated a positive correlation between heuristic severity and safety severity ratings. Regression analysis demonstrated that 49% of safety risk variability by clinical safety professionals ( = 0.70; = 28) and 42% of safety risk variability by clinical informatics specialists ( = 0.65; = 28) was explained by usability severity scoring of problems outlined by heuristic evaluation. Higher severity ratings of the usability issues were associated with increased perceptions of patient safety risk.
This study demonstrated the use of heuristic evaluation as a technique to quickly identify usability problems in an EHR that could lead to safety issues. Detection of higher severity ratings could help prioritize failures in EHR design that more urgently require design changes. This approach is a cost-effective technique for improving usability while impacting patient safety.
Results from this study demonstrate the efficacy of the heuristic evaluation technique to identify usability problems that impact safety of the EHR. Also, the use of interdisciplinary teams for evaluation should be considered for severity assessment.
电子健康记录（EHR）的可用性仍然具有挑战性，而糟糕的 EHR 设计会对患者安全产生影响。启发式评估可检测出可归类为严重程度的可用性问题。国家标准与技术研究所（National Institute of Standards and Technology）提供了 EHR 可用性的安全量表。我们的目的是研究启发式严重程度评级与安全量表评级之间的关系，以分析 EHR 安全性。
对七种常见的移动 EHR 任务进行了启发式评估，共发现 58 个启发式违规行为和 28 个独特的可用性问题。每个可用性问题都由经过培训的医院医生和人类因素研究员独立进行严重程度评分，并由两名医师信息专家和两名临床安全专家进行安全严重程度评分。
结果表明，启发式严重程度和安全严重程度评分之间存在正相关关系。回归分析表明，临床安全专业人员（ = 0.70； = 28）和临床信息学专家（ = 0.65； = 28）的安全风险变异的 49%可以通过问题的可用性严重程度评分来解释，这些问题是由启发式评估中列出的可用性问题得出的。可用性问题的严重程度评分越高，与患者安全风险感知的增加相关。
本研究证明了启发式评估作为一种快速识别 EHR 中可能导致安全问题的可用性问题的技术的有效性。检测到更高的严重程度评分可以帮助确定 EHR 设计中需要紧急更改的设计缺陷。这种方法是一种在提高可用性的同时影响患者安全的具有成本效益的技术。
本研究结果证明了启发式评估技术在识别影响 EHR 安全性的可用性问题方面的有效性。此外，应考虑使用跨学科团队进行评估，以进行严重程度评估。
