Three-Step Process For Design Evaluation And User Performance Testing For An EHR

Background of the project

It is found that prior to the year 1960; all medical records were generally kept on paper and in different manual filling system. All the reports including diagnoses, visit notes as well as medical directions are generally written as well as maintained using paper sheets and were mainly labeled using patient’s last name, security number and other chart numbering system. In the mid of 1960’s an electronic system was mainly developed by Lockheed and after then other technology as well as engineering companies generally started developing medical health record system for hospitals. In the year 1991, institute of medicine generally implemented the result of the study that was mainly undertaken for studying the utilization of paper record. The report mainly helps in arguing the case of utilizing EHR as one of the key recommendation that generally helps in improving the patient’s record. By the year 2004, the requirement of conversion of various medical records to EHRs was mainly recognized with the creation of ONC and health information technology. Today, EHR is considered as one of the secure as well as effective tool that helps in maintaining patient’s health care data in order to communicate with patients as well as for supporting the patient-physician relationship.

Electronic health record system generally assists in providing accurate as well as up to date information to the patients. The utilization of EHR system helps in enabling quick access within the records of the patient for more coordinated as well as efficient care. In addition to this, use of electronic health record system also helps in securely sharing information of the patients and further assists providers in properly diagnosing patients, reduce medical errors and more.

The motivation for the project is to analyze the potential impact of usability issues of electronic health record system and to determine systematic steps that are helpful in conducting proper validation studies. It is identified that validation study generally helps in guiding in order to provide help and for assuring that the user interface of the application is free from various types of critical usability issues for supporting error-free user interaction. The project mainly includes three step procedures that mainly incorporate validation procedure as well as evaluation for designing human user performance testing as well as for designing evaluation. The procedure mainly focused on enhancing safe utilization of electronic health record system for increasing the ease of EHR utilization.

Motivation for the project

 It is found that usability is one of the important factors that are generally hindering widespread adoption of electronic health record system. Poor usability of electronic health record system generally helps in inhibiting proper utilization of the system and in some extreme cases it can put the patients in danger. Due to poor as well as cumbersome design of the interfaces, the users got frustrated which can impact patient health care in a negative way. Improper usability helps in decreasing clinical productivity, as well assists in enhancing error rate.

 The scopes of the project are categorized into in-scope as well as out-scope.

In scope: In scope of the project include:

• Reviewing user interfaces of electronic health record system
• Testing user interface of electronic health record system
• Designing user interface as per the usability engineering principles
• Completion of project within 3 months
• Completion of project within $40,000

Out-scope: Out-scope of the project includes:

• Project stakeholder involved with the project are not elaborated
• Assumptions associated with the project is not done

The objectives of the project are as follows:

• To  evaluate and validate procedures for design evaluation and human user performance testing for an EHR system
• To enhance safe use of electronic health record system
• To increase ease of utilizing electronic health record system by users

6.1. Review of the EHR’s user interface design

The Electronic Health Record (EHR) has advantage of the design of user interface and the user experience. According to Zahabi, Kaber, and Swangnetr (2015) there are many principle that are related with the user interface design of EHR. EHR provides learnability, which ensures that the software that will be designed will be easy to learn for the workers to start their work fast with the EHR system. EHR also provides user familiarity, which states that the interface should be able to use the concepts and the terms that are drawn from people’s experience who are in touch with the software. The EHR also provides consistency, which says that the interface of the EHR must be consistent because the operations with other comparable should also be activated. The behavior of the software should be common with no surprises while using the software because the user will have difficulty to use the software (Hanauer et al. 2015). The principle of EHR also states that the software should have more recoverable capability of the error that is faced by the users. The interface of the system should give the feedback of all the errors that are related with the software and should have the guidance to help the user. The system should have the mechanisms for different types of user. Many safety risks are related to the EHR system.

The first risk comes is the financial risk that may arise while developing the system. The financial cost including the implementation cost an the adoption cost is much more with EHR system. There are many hardware and software that are to be implemented while using the system. Maintenance cost of the system is also very high. The software must be updated from time to time and the hardware is to be replaced on time basis. There should also be training describing the system so that the system becomes user friendly. There is another risk that is associated with the EHR system. The work flow in between the medical staffs and the system providers is generally disrupted that result in productivity loss for the system. There is also a risk of having a violation in the data of the patients. In an online system, there always lies a risk of having data breach in the system. The data that are exchanged electronically can be hacked which increases the concern related to the information of the patients.

Problem statement

The designs of the EHR have a great efficiency on the health record system. The EHR improves the organizational efficiency of the health care in which the software is used. The staffs that use the software can have quick access to all the records of the system. The records of the patients are easily accessible and time is being saved while using the software (Meeks et al. 2014). The information of the patients is available to all the staffs at same time which helps to process and locate the information of the patient efficiently. The EHR system improves the management of the medical practice. There are automated coding, progress notes in the system of EHR that make the system more efficient. The headache of paperwork is reduced in using the electronic system of health management.

6.2. Usability testing of the EHR’s system

According to Pivovarov and Elhadad (2015) to maintain the critical usability issues that may potentially impact safety of the EHR in implementing AMIA for maintaining the safety of the patients and produce quality care service to the patients with improved usability. As stated by Thyvalikakath et al. (2014) the main purpose of AMIA is to stimulate the informed debate, increase the understanding of usability of effectiveness of health, and helps to give a care of high quality and a safer quality of work. In usability, the issues that are involved are i) effective and safe use of the EHR, ii) usability of EHR, and iii) the medical errors that are associated with EHR usability. Analyses to barriers that are related to physicians and the facilitators, using the EHR system also suggests the usability system with functionality, hardware support, learning time, speed, strategies of user development, workarounds, understand the system of EHR, and typing proficiency. The attributes that are associated with the usability has huge range of quantitative methods and qualitative methods.

EHRs are generally computerized health information system that are used to store , display, and collect the information of the patients. The EHR helps to create organized recordings and create legible recordings (Nelson and Staggers 2016). EHRs are use to access all the clinical information of the individual information in the system. There are economic and social interests in different countries, the physicians play an important role to use the EHRs. There are many advantages of using the EHR system and different forms of technology used in health care systems. Simpao et al. (2014) stated that the health care organizations slowly adopted the technology of EHR. The lack in readiness mainly causes the weakness in the organization so that they may undergo the transformation while implementing the technology of EHR. Adoption in slow rate generally suggests the resistance among the physicians.

Scope of the project

 A new technology that is to be adopted by the healthcares helps to reduce the time consumption, reduce the burden of using paper and pen, ad increase the efficiency of the healthcare. The problems that decreases the efficiency of the system of EHR are misinformation, misinterpretation, and miscommunication in between the clinic executives, end users, IS leaders, and vendors, which basically creates barrier in selecting, utilization, marketing, implementation, and selecting the Electronic Health Record system. From EHR, service co-ordination is expected so that the quality of the service can be improved with safety of the system (Dinev et al. 2016). There should be supported developing plan, improve the quality of documentation, increase efficiency, enhance team communication, and does all the nursing tasks. There is high rate of adoption of electronic health record in all the health care system. The Institute of Medicine has adopted the EHR at a very high scale to improve the safety of the patients.

6.3. Proposal of the user interface as per the usability engineering principles

According to Hsiao, Hing and Ashman (2014), a proper interface design for the electronic health record system will e proposed that helps in addressing several of the usability deficiencies that are generally associated with electronic health record system. It is identified that the newly proposed interface will mainly separate data as well as information as per the various divisions of the healthcare so that the user does not have to invest much time in searching for a historical data of a patient (Xhafa et al. 2015). The design also include proper log in facility so that valid user can only access the information as well as data which further helps in increasing privacy as well as security of the system.  In order to enhance usability of the users, the interface must include typesetting buttons.

 It is stated by Andrus et al. (2015) that proper typesetting buttons helps in providing more balanced look. The design of the interface is so simple that the cost which is associated with the design of the interface is very much less. In addition to this, the newly designed interface so contain the review section which is useful for the users. If the users are facing any sort of problem related with the electronic health record system then can put a complainant or suggestion there so that the system can be improved much more (Madden et al. 2016). Moreover, the interface will include a help option where proper procedure of logging within the system to checking the health record history is provided so that the patients who do not know the procedure of operation can be able to get information for accessing their account in order to access proper information as well as data.

Project objectives

 The project requirement is mainly divided into functional and non functional requirement.

Functional project requirement

The functional requirements of the project are as follows:

Authentication: Proper authentication facility is provided by the electronic health record system so that data as well as information associated with the patients as well as healthcare can be stored successfully (Safa, Von Solms and Furnell 2016).

Administrative functions: All the administrative functions are generally managed with the help of the electronic health record system.

Historical data: With the help of the electronic health record system, the authenticated members can be able to access the historical data of the patients whenever necessary.

Non-functional project requirement

The non-functional requirements of the project are as follows:

Scalability: The electronic health record system is scalable which means it can successfully handle various functions of the system for accommodating growth (Kerzner and Kerzner 2017).

Security: The electronic health record system assists in enhancing privacy as well as security of patient’s data so that it cannot be misused.

Manageability: All the data as well as information that are associated with the patients are generally stored as well as managed with the help of electronic health record system so that the care coordination of the patient will increase (Schwalbe, 2015).

Usability: The usability of the system is improved for enhancing safe use of the electronic health record system by increasing the utilization of EHR’s by the various users

In order to use Electronic health record system safely and for enhancing the ease of use for the users following solutions need to be followed:

Authentication: Proper authentication facility needs to be provided in order to secure the data as well as information about the patients (Laudon and Laudon 2016). It is identified that proper authentication helps in utilizing electronic health record system quite safely without facing nay problem

Improving usability of the system: The interface usability of the system must be improved by adopting proper steps as well as methods so that the users can easily use the system without facing nay problem.

Workforce education and training: In order to safeguard the patient health information, it is very much necessary for the workforce to implement proper policies as well as security audits so that the system can be used safely (Safa,  Von Solms and Furnell 2016).

Communication with users: Proper communication with the patients is helpful in implementing steps that are beneficial for the users which further enhance ease for the users.

Analysis of related work/Literature Review

The expected outcomes are as follows:

Enhance usability of the system: The interface usability of electronic health record system will be improved and as a result the users can be able to use the system without facing nay difficulty.

Successful completion of the project within the assumed budget and time: It is expected that the entire project will be completed within the estimated budget and time by maintaining the project scope.

Meeting objectives of the project: The project will meet all the objectives of the project so that the entire system will be improved for providing proper ease of use to the various users.

10.1 Work Plan

Task Name	Duration	Start	Finish
Usability of Electronic Health Record System	120 days	Tue 2/27/18	Mon 8/13/18
Initiation phase	10 days	Tue 2/27/18	Mon 3/12/18
Developing business case	3 days	Tue 2/27/18	Thu 3/1/18
Undertaking feasibility study	2 days	Fri 3/2/18	Mon 3/5/18
Establishing project charter	2 days	Tue 3/6/18	Wed 3/7/18
Appointing team members of the project	3 days	Thu 3/8/18	Mon 3/12/18
Milestone 1: Completion of initiation phase	0 days	Mon 3/12/18	Mon 3/12/18
Planning phase	18 days	Tue 3/13/18	Thu 4/5/18
Creation of project plan	3 days	Tue 3/13/18	Thu 3/15/18
Creating resource plan	3 days	Fri 3/16/18	Tue 3/20/18
Developing financial plan	4 days	Wed 3/21/18	Mon 3/26/18
Creating quality plan	3 days	Tue 3/27/18	Thu 3/29/18
Development of risk management plan	2 days	Fri 3/30/18	Mon 4/2/18
Development of acceptance plan	3 days	Tue 4/3/18	Thu 4/5/18
Milestone 2: Completion of planning phase	0 days	Thu 4/5/18	Thu 4/5/18
Execution phase	88 days	Fri 4/6/18	Tue 8/7/18
Analysis of the EHR user interface	22 days	Fri 4/6/18	Mon 5/7/18
Comparison of EHR usability design	6 days	Fri 4/6/18	Fri 4/13/18
Identification of EHR interface scientific design principles	5 days	Mon 4/16/18	Fri 4/20/18
Identification of possible safety risks	6 days	Mon 4/23/18	Mon 4/30/18
Identification of areas for improving efficiency	5 days	Tue 5/1/18	Mon 5/7/18
Usability testing of EHR	29 days	Tue 5/8/18	Fri 6/15/18
Examination of performance	7 days	Tue 5/8/18	Wed 5/16/18
Recording objective data	6 days	Thu 5/17/18	Thu 5/24/18
Recording subjective data	5 days	Fri 5/25/18	Thu 5/31/18
Assuring absence of various critical barriers	6 days	Fri 6/1/18	Fri 6/8/18
Proposed interface design for EHR	5 days	Mon 6/11/18	Fri 6/15/18
Proposed interface design	37 days	Mon 6/18/18	Tue 8/7/18
Understanding concept	6 days	Mon 6/18/18	Mon 6/25/18
Brainstorming	7 days	Tue 6/26/18	Wed 7/4/18
User flow diagram	8 days	Thu 7/5/18	Mon 7/16/18
Structure and flow validation	6 days	Tue 7/17/18	Tue 7/24/18
Choosing the style of the interface	10 days	Wed 7/25/18	Tue 8/7/18
Style validation	9 days	Wed 7/25/18	Mon 8/6/18
Milestone 3: Completion of execution phase	0 days	Tue 8/7/18	Tue 8/7/18
Closure phase	4 days	Wed 8/8/18	Mon 8/13/18
Post project review	2 days	Wed 8/8/18	Thu 8/9/18
Stakeholder sign off	1 day	Fri 8/10/18	Fri 8/10/18
Documentation	1 day	Mon 8/13/18	Mon 8/13/18
Milestone 4: Completion of closure phase	0 days	Mon 8/13/18	Mon 8/13/18

 

Figure 1: Gantt chart

(Source: Created by Author)

 

Figure 2: WBS

(Source: Created by Author)

Task Name	Cost
Usability of Electronic Health Record System	$44,664.00
Initiation phase	$2,760.00
Developing business case	$888.00
Undertaking feasibility study	$560.00
Establishing project charter	$592.00
Appointing team members of the project	$720.00
Milestone 1: Completion of initiation phase	$0.00
Planning phase	$6,208.00
Creation of project plan	$840.00
Creating resource plan	$720.00
Developing financial plan	$1,760.00
Creating quality plan	$1,440.00
Development of risk management plan	$560.00
Development of acceptance plan	$888.00
Milestone 2: Completion of planning phase	$0.00
Execution phase	$34,528.00
Analysis of the EHR user interface	$6,816.00
Comparison of EHR usability design	$1,536.00
Identification of EHR interface scientific design principles	$1,280.00
Identification of possible safety risks	$1,440.00
Identification of areas for improving efficiency	$2,560.00
Usability testing of EHR	$11,984.00
Examination of performance	$3,864.00
Recording objective data	$1,440.00
Recording subjective data	$2,680.00
Assuring absence of various critical barriers	$1,440.00
Proposed interface design for EHR	$2,560.00
Proposed interface design	$15,728.00
Understanding concept	$1,536.00
Brainstorming	$1,792.00
User flow diagram	$2,048.00
Structure and flow validation	$3,072.00
Choosing the style of the interface	$5,120.00
Style validation	$2,160.00
Milestone 3: Completion of execution phase	$0.00
Closure phase	$1,168.00
Post project review	$592.00
Stakeholder sign off	$296.00
Documentation	$280.00
Milestone 4: Completion of closure phase	$0.00

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