First name
Jeritt
Middle name
G
Last name
Thayer

Title

Human-centered development of an electronic health record-embedded, interactive information visualization in the emergency department using fast healthcare interoperability resources.

Year of Publication

2021

Date Published

2021 Mar 03

ISSN Number

1527-974X

Abstract

<p><strong>OBJECTIVE: </strong>Develop and evaluate an interactive information visualization embedded within the electronic health record (EHR) by following human-centered design (HCD) processes and leveraging modern health information exchange standards.</p>

<p><strong>MATERIALS AND METHODS: </strong>We applied an HCD process to develop a Fast Healthcare Interoperability Resources (FHIR) application that displays a patient's asthma history to clinicians in a pediatric emergency department. We performed a preimplementation comparative system evaluation to measure time on task, number of screens, information retrieval accuracy, cognitive load, user satisfaction, and perceived utility and usefulness. Application usage and system functionality were assessed using application logs and a postimplementation survey of end users.</p>

<p><strong>RESULTS: </strong>Usability testing of the Asthma Timeline Application demonstrated a statistically significant reduction in time on task (P &lt; .001), number of screens (P &lt; .001), and cognitive load (P &lt; .001) for clinicians when compared to base EHR functionality. Postimplementation evaluation demonstrated reliable functionality and high user satisfaction.</p>

<p><strong>DISCUSSION: </strong>Following HCD processes to develop an application in the context of clinical operations/quality improvement is feasible. Our work also highlights the potential benefits and challenges associated with using internationally recognized data exchange standards as currently implemented.</p>

<p><strong>CONCLUSION: </strong>Compared to standard EHR functionality, our visualization increased clinician efficiency when reviewing the charts of pediatric asthma patients. Application development efforts in an operational context should leverage existing health information exchange standards, such as FHIR, and evidence-based mixed methods approaches.</p>

DOI

10.1093/jamia/ocab016

Alternate Title

J Am Med Inform Assoc

PMID

33682004

Title

Assessing the Safety of Custom Web-Based Clinical Decision Support Systems in Electronic Health Records: A Case Study.

Year of Publication

2019

Number of Pages

237-246

Date Published

2019 Mar

ISSN Number

1869-0327

Abstract

<p><strong>BACKGROUND: </strong> With the widespread adoption of vendor-supplied electronic health record (EHR) systems, clinical decision support (CDS) customization efforts beyond those anticipated by the vendor may require the use of technologies external to the EHR such as web services. Pursuing such customizations, however, is not without risk. Validating the expected behavior of a customized CDS system in the high-volume, complex environment of the live EHR is a challenging problem.</p>

<p><strong>OBJECTIVE: </strong> This article identifies technology failures that impacted clinical care related to web service-based advanced custom CDS systems embedded in the complex sociotechnical context of a production EHR.</p>

<p><strong>METHODS: </strong> In an academic health system's primary care network, we performed an inventory of incidents between January 1, 2008 and December 31, 2016 related to a customized CDS system and performed a targeted review of changes in the CDS source code. Additional feedback on the root cause of individual incidents was obtained through interviews with members of the CDS project teams.</p>

<p><strong>RESULTS: </strong> We identified five CDS malfunctions that impaired clinical workflow. The mechanisms for these failures are mapped to four characteristics of well-behaved applications: (1) system integrity; (2) data integrity; (3) reliability; and (4) scalability. Over the 9-year period, two malfunctions of the customized CDS significantly impaired clinical workflow for a total of 5 hours. Lesser impacts-loss of individual features with straightforward workarounds-arose from three malfunctions, which affected users on 53 days.</p>

<p><strong>DISCUSSION: </strong> Advanced customization of EHRs for the purpose of CDS can present significant risks to clinical workflow.</p>

<p><strong>CONCLUSION: </strong> This case study highlights that advanced customization of CDS within a commercial EHR may support care for complex patient populations, but ongoing monitoring and support is required to ensure its safe use.</p>

DOI

10.1055/s-0039-1683985

Alternate Title

Appl Clin Inform

PMID

30943572

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