Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; eHealth NSW, Australia.
Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
Int J Med Inform. 2023 Apr;172:105017. doi: 10.1016/j.ijmedinf.2023.105017. Epub 2023 Feb 9.
Poorly designed electronic medication management systems (EMMS) or computerized physician order entry (CPOE) systems in hospital settings can result in usability issues and in turn, patient safety risks. As a safety science, human factors and safety analysis methods have potential to support the safe and usable design of EMMS.
To identify and describe human factors and safety analysis methods that have been used in the design or redesign of EMMS used in hospital settings.
A systematic review, following PRISMA guidelines, was conducted by searching online databases and relevant journals from January 2011 to May 2022. Studies were included if they described the practical application of human factors and safety analysis methods to support the design or redesign of a clinician-facing EMMS, or its components. Methods used were extracted and mapped to human centered design (HCD) activities: understanding context of use; specifying user requirements; producing design solutions; and evaluating the design.
Twenty-one papers met the inclusion criteria. Overall, 21 human factors and safety analysis methods were used in the design or redesign of EMMS with prototyping, usability testing, participant surveys/questionnaires and interviews the most frequent. Human factors and safety analysis methods were most frequently used to evaluate the design of a system (n = 67; 56.3%). Nineteen of 21 (90%) methods used aimed to identify usability issues and/or support iterative design; only one paper utilized a safety-oriented method and one, a mental workload assessment method.
While the review identified 21 methods, EMMS design primarily utilized a subset of available methods, and rarely a method focused on safety. Given the high-risk nature of medication management in complex hospital environments, and the potential for harm due to poorly designed EMMS, there is significant potential to apply more safety-oriented human factors and safety analysis methods to support EMMS design.
在医院环境中，设计不佳的电子医嘱管理系统（EMMS）或计算机化医师医嘱录入（CPOE）系统可能会导致可用性问题，进而带来患者安全风险。作为安全科学，人因工程和安全分析方法有可能支持 EMMS 的安全和可用设计。
确定并描述已在医院环境中使用的 EMMS 设计或重新设计中使用的人因工程和安全分析方法。
按照 PRISMA 指南进行系统回顾，通过在线数据库和相关期刊搜索，检索时间为 2011 年 1 月至 2022 年 5 月。如果研究描述了人因工程和安全分析方法在支持面向临床医生的 EMMS 或其组件的设计或重新设计中的实际应用，则纳入研究。提取所使用的方法并映射到人因工程设计（HCD）活动：了解使用情境；规定用户需求；生成设计解决方案；评估设计。
符合纳入标准的论文有 21 篇。总体而言，21 种人因工程和安全分析方法用于 EMMS 的设计或重新设计，其中原型设计、可用性测试、参与者调查/问卷和访谈最为常见。人因工程和安全分析方法最常用于评估系统设计（n=67；56.3%）。21 种方法中的 19 种（90%）旨在确定可用性问题并/或支持迭代设计；只有一篇论文使用了面向安全的方法，一篇论文使用了心理负荷评估方法。
虽然该综述确定了 21 种方法，但 EMMS 设计主要使用了现有方法中的一部分，很少使用专门针对安全的方法。鉴于在复杂医院环境中药物管理的高风险性质以及设计不佳的 EMMS 可能带来的伤害风险，有很大的潜力可以应用更多面向安全的人因工程和安全分析方法来支持 EMMS 设计。
