Human-technology Interface

The Use of Human-Technology Interface in Clinical Practice

Instructions: Below is the prompt that Sheila and Sylvia responded to. Please respond back to them in response to their individual discussions and utilizes scholarly sources when responding

Prompt: Identify a human-technology interface you encountered in clinical practice which needs improving. Provide a detailed replacement plan for the interface incorporating one of the axioms presented in the readings this week. How can this interface improve patient care?

Sheilah

The assignment is to identify a human-technology interface I have experienced in my clinical practice that I believe should be changed.  The human-technology interface I have chosen to discuss and develop a replacement plan for is the communication of lab results to my patients using the patient portal.  In the health care field the human-technology interface is defined in many ways but simply is the interaction of the health care personnel with technology which may include electronic medical records (EMR) , monitors, intravenous pumps, defibrillators, smartphones and pagers (Wixom, 2015).

The Health Information Technology for Economic Clinical Health (HITECH) Act of 2009 placed requirements on health care organizations (HCOs) to participate in meaningful use activities in order to receive reimbursements from the federal government.  Developing and utilizing a patient portal allowed the HCOs to meet one of the Stage 2 criteria for patient involvement.  A patient’s participation in the portal theoretically should increase the patient’s participation in their health care decisions (Kruse, Bolton and Freriks, 2015).  EMRs should be developed so that patients will have easy access to their health information that is presented in a meaningful manner.  Portals allow the patient access to their electronic health record which allows them to see appointment dates and times, medication list, vital signs, visit notes and their laboratory and imaging results (Wixom, 2015).

In the Cerner system I use in my clinical practice, when completed, a patient’s lab results will appear in the ordering provider’s inbox.   The provider will review the results and based on the results and the associated diagnosis for which the labs were ordered, will determine how to notify the patient.  If the patient is signed up for the portal and the lab results are normal other than perhaps some elevation in the lipid profile parameters or a low vitamin D level, the provider will be able to send an email message to the patient and the lab results are attached.   The provider has to free text the message to the patient explaining the lab results.   The providers have developed a “workaround” for the free texting process.  They have created numerous auto-texting options and each provider has his/her own list.  “A workaround is a method of accomplishing an activity when the usual system/process is not working well” (PA Patient Safety Reporting System, 2005).  Mastrian and McGonigle (p. 143, 2017) state that “work-arounds are only a Band-Aid; they are not a long-term solution.”  They provide an opportunity to fix a problem in the system.

My concern about our current system is two-fold.  First, the amount of time a provider has to spend generating explanations and recommendations for care based on the test results.  And the main reason for the need to free text the explanations is that the lab results are presented to the patient in the exact format the provider sees them.   For instance, the sodium level is seen as “Na”, the glucose is seen as “Glu”, the triglyceride level is seen as “TG”.   Therefore, the providers have to spend a lot of time explaining what abbreviations mean.   And when the complete blood count (CBC) indices are off by a few points and are “high” or “low” many patients want an explanation for these.  The patients are able to see their lab results within seventy-two hours of completion.  There are times when due to a provider’s schedule, the patient sees the results before the provider and then is either calling the office or sending several emails through the portal until they get an answer.  Mastrian and McGonigle (p. 143) stated that poor technology designs may lead to errors in care and decreased productivity of providers.

The axiom I have chosen to improve this human-technology interface problem is “Axiom 1: Users must be an early and continuous focus during interface design” (Mastrian&McGonigle, p. 147).  Axiom 1 is focused on the end-user of the technology.  Several levels of analysis are used in order to assess the physical, psychological, team, organizational and political needs of the users (Mastrian&McGonigle, p. 147).

I will propose to the Connected team (this is the EMR personnel that work with the Cerner vendor) that the lab reporting format for the patient portal must be changed to provide a more simple explanation of the results.  They would then discuss with Cerner what the plan would be for changing the current system.  Using the cognitive task analysis method (Mastrian&McGonigle, p. 148) the team would begin to identify the process for proceeding with the changes.  Questionnaires will need to be developed to give out to patients for their input into creating a more simplified explanation of their lab results.  A web-based survey will be developed to send out to providers for their input into a scripted response for the most common lab tests.   As stated previously, Axiom 1 is focused on how the results affect the end-user.

I believe that a lab interface that will display the test results more clearly i.e.: “Na” becomes “sodium” and includes a basic explanation the providers can use as a default will provide increased patient satisfaction because they will have a simplified more timely access to their test results.   This may encourage other patients to sign up for the portal.  This change will save time for the providers as well.

References

Kruse, C.S., Bolton, K., Freriks, G. (2015). The effect of patient portals on quality outcomes

and its implications to meaningful use: a systematic review. Journal of Medical Internet

      Research 17 (2): e44.  DOI: 10.2196/jmir.3171.

Pennsylvania Patient Safety Reporting System (2005). Workarounds: a sign of opportunity

knocking.  Pennsylvania Patient Safety Authority2 (4): 25-28.

Retrieved http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2005/dec2(4)/

Pages/25.aspx.

Mastrian, K. G., McGonigle, D. (2017). Informatics for health professionals. Burlington MA:

Jones & Bartlett Learning.

Wixom, T. (2015). The human-technology interface and nursing.  Nursing Informatics

     Retrieved http://nursinginformaticstiffanywixom.blogspot.com/2015/02/the-human-

technology-interface-and.html

Sylvia

Not long ago, Dr. M., one of the physicians I work with at the hospital asked me, “where do you get all this information on the patients?” The information Dr. M. was referring to is the information from the EHR. I explained, “before we round, I have spoken with the patients’ nurse, looked through the entire EHR for new results, consultation notes, nurse’s notes, and therapy notes, this way, I can update you and the other physicians while we make rounds”. After explaining to Dr. M. how I extract all the information, he was taken aback as to all the information available at is fingertips that he was not aware of.

Describing cognitive engineering, human factors, and ergonomics (p.147) as elements necessary to produce an interface that benefits both the user and the environment, Mastrian and McGonigle (2017) have established three axioms for improving the effectiveness of the human-computer interaction while minimizing stress and maximizing efficiency.  In the above scenario, Axiom 2: The design process should be iterative, allowing for evaluation and correction of identified problems can be applied. Information in the EHR can provide a multidisciplinary view of the patient, but for the user to access the information a more user friendly approach, with easier accessibility to the multidisciplinary notes would be justified.  Mastrain and McGonigle (2017) recommend utilizing Normans’ principles, the human interface can be simple, straightforward, and effective.

The Cerner system we use is very user friendly but extracting information from each discipline can be time consuming. Results of vital signs, laboratory data, microbiology, pathology, and education are all easily accessible from the same tool bar. But reviewing notes by physician (admitting, consultation notes, and progress), nursing, social services, PT, OT, and ST require the user to navigate through different areas of the EHR. By understanding how user knowledge of the EHR, knowledge from our education, experience, observations, and knowledge of the environment are connected, the human technology interface can be simplified by developing an EHR that standardizes how information is extracted (Mastrian and McGonigle, 2017).

To improve accessibility to the current Cerner system I would make following changes:

• Continue the icon toolbar to include orders and notes from the different disciplines. For example, this would be helpful while a user is reviewing lab values. If an abnormal liver function test noted, the user can easily choose the orders icon to see if a gastroenterology consult has been placed and or click on radiology to see if an abdominal US has been ordered and or ready for review without having to exit out of one screen then go back to continue reviewing the EHR. In Norman’s principles, Mastrian and McGonigle (2017) recommend simplifying the steps. The EMR acts as storage for patient information through the varies disciplines, supporting the course of the hospital stay (Zahabi, Kaber, and Swangnetr (2015). Therefore, design principles of the EHR must be specific to the needs of the user with a simplified format (Saleem, Herout, and Wilck, 2016).

 
This an example of the current Cerner toolbar:

I would design the toolbar to include the order screen and documentation screens.

• I would also add a pop up alert to indicate when new results have populated onto the patients record. For example, if microbiology results are ready to view, an alert in the form of a pop up blinking light in microbiology would be visible. Providing a visual cue (pop up) that the result is ready will capture the user’s attention. In their research, Rayo et al. (2015) report that not only do dynamically annotated visualizations (DAV) or pop ups, reduce the number of duplicate orders, DAVs were shown to be more effective than traditional alerts, such as a red flag alert.

The electronic health record (EHR), a digital version of the traditional paper chart has impacted the healthcare system positively and negatively. Usability of an any EHR, and the lack therefore can be related EHR design. Mastrain and McGonigle (2017) recommend a design process which are iterative, that are can be evaluated and corrected when problems have been identified. An EHR can be an effective tool in improving the flow of information across the disciplines as well as improving patient safety.

References

Mastrain K., &McGonigle, D. (2017). Informatics for health professionals. Burlington, MA: Jones &   Bartlett Learning.

Rayo, M.F., Kowalczyk, N., Liston, B.W., Sanders, E.B., White, S., and Patterson, E.S. (2015). Comparing the effectiveness of alerts and dynamically annotated visualizations (DAVs) in improving clinical decision making. Human Factors, 57 (6), PP. 1002-1014. Doi:10.1177/0018720815585666

Saleem, J.J., Herout, J., and Wilck, N.R. (2016). Function-specific design principles for the electronic health record. Human Factors. DOI: 10.1177/1541931213601133

Zahabi, M.  Kaber, D.B., and Swangnetr, M. (2015). Usability and safety in electronic medical records interface design: a review of recent literature and guideline formulation. Human Factors, 57 (5), pp. 805-834. DOI: 10.1177/0018120815576827