First name
Amy
Last name
Will

Title

A Heuristic Evaluation to Assess Use of After Visit Summaries for Supporting Continuity of Care.

Year of Publication

2018

Number of Pages

714-724

Date Published

2018 07

ISSN Number

1869-0327

Abstract

<p><strong>BACKGROUND: </strong>Outpatient providers often do not receive discharge summaries from acute care providers prior to follow-up visits. These outpatient providers may use the after-visit summaries (AVS) that are given to patients to obtain clinical information. It is unclear how effectively AVS support care coordination between clinicians.</p>

<p><strong>OBJECTIVES: </strong>Goals for this effort include: (1) developing usability heuristics that may be applied both for assessment and to guide generation of medical documents in general, (2) conducting a heuristic evaluation to assess the use of AVS for communication between clinicians, and (3) providing recommendations for generating AVS that effectively support both patient/caregiver use and care coordination.</p>

<p><strong>METHODS: </strong>We created a 17-item heuristic evaluation instrument for assessing usability of medical documents. Eight experts used the instrument to assess each of four simulated AVS. The simulations were created using examples from two hospitals and two pediatric patient cases developed by the National Institute of Standards and Technology.</p>

<p><strong>RESULTS: </strong>Experts identified 224 unique usability problems ranging in severity from mild to catastrophic. Content issues (e.g., missing medical history, marital status of a 2-year-old) were rated as most severe, but widespread formatting and structural problems (e.g., inconsistent indentation, fonts, and headings; confusing ordering of information) were so distracting that they significantly reduced readers' ability to efficiently use the documents. Overall, issues in the AVS from Hospital 2 were more severe than those in the AVS from Hospital 1.</p>

<p><strong>CONCLUSION: </strong>The new instrument allowed for quick, inexpensive evaluations of AVS. Usability issues such as unnecessary information, poor organization, missing information, and inconsistent formatting make it hard for patients, caregivers, and clinicians to use the AVS. The heuristics in the new instrument may be used as guidance to adapt electronic health record systems so that they generate more useful and usable medical documents.</p>

DOI

10.1055/s-0038-1668093

Alternate Title

Appl Clin Inform

PMID

30208496

Title

Identifying Electronic Health Record Usability And Safety Challenges In Pediatric Settings.

Year of Publication

2018

Number of Pages

1752-1759

Date Published

2018 11

ISSN Number

1544-5208

Abstract

<p>Pediatric populations are uniquely vulnerable to the usability and safety challenges of electronic health records (EHRs), particularly those related to medication, yet little is known about the specific issues contributing to hazards. To understand specific usability issues and medication errors in the care of children, we analyzed 9,000 patient safety reports, made in the period 2012-17, from three different health care institutions that were likely related to EHR use. Of the 9,000 reports, 3,243 (36&nbsp;percent) had a usability issue that contributed to the medication event, and 609 (18.8&nbsp;percent) of the 3,243 might have resulted in patient harm. The general pattern of usability challenges and medication errors were the same across the three sites. The most common usability challenges were associated with system feedback and the visual display. The most common medication error was improper dosing.</p>

DOI

10.1377/hlthaff.2018.0699

Alternate Title

Health Aff (Millwood)

PMID

30395517

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