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Multi-method laboratory user evaluation of an actionable clinical performance information system: Implications for usability and patient safety

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journal contribution
posted on 07.12.2020, 15:00 by B Brown, Panagiotis BalatsoukasPanagiotis Balatsoukas, R Williams, M Sperrin, I Buchan
© 2017 The Authors Introduction Electronic audit and feedback (e-A&F) systems are used worldwide for care quality improvement. They measure health professionals’ performance against clinical guidelines, and some systems suggest improvement actions. However, little is known about optimal interface designs for e-A&F, in particular how to present suggested actions for improvement. We developed a novel theory-informed system for primary care (the Performance Improvement plaN GeneratoR; PINGR) that covers the four principal interface components: clinical performance summaries; patient lists; detailed patient-level information; and suggested actions. As far as we are aware, this is the first report of an e-A&F system with all four interface components. Objectives (1) Use a combination of quantitative and qualitative methods to evaluate the usability of PINGR with target end-users; (2) refine existing design recommendations for e-A&F systems; (3) determine the implications of these recommendations for patient safety. Methods We recruited seven primary care physicians to perform seven tasks with PINGR, during which we measured on-screen behaviour and eye movements. Participants subsequently completed usability questionnaires, and were interviewed in-depth. Data were integrated to: gain a more complete understanding of usability issues; enhance and explain each other's findings; and triangulate results to increase validity. Results Participants committed a median of 10 errors (range 8–21) when using PINGR's interface, and completed a median of five out of seven tasks (range 4–7). Errors violated six usability heuristics: clear response options; perceptual grouping and data relationships; representational formats; unambiguous description; visually distinct screens for confusable items; and workflow integration. Eye movement analysis revealed the integration of components largely supported effective user workflow, although the modular design of clinical performance summaries unnecessarily increased cognitive load. Interviews and questionnaires revealed PINGR is user-friendly, and that improved information prioritisation could further promote useful user action. Conclusions Comparing our results with the wider usability literature we refine a previously published set of interface design recommendations for e-A&F. The implications for patient safety are significant regarding: user engagement; actionability; and information prioritisation. Our results also support adopting multi-method approaches in usability studies to maximise issue discovery and the credibility of findings.

Funding

Wellcome Trust Research Training Fellowship for BB [104438/Z/14/Z]

MICA: Health e-Research Centre

Medical Research Council

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History

School

  • Design and Creative Arts

Department

  • Design

Published in

Journal of Biomedical Informatics

Volume

77

Pages

62 - 80

Publisher

Elsevier

Version

VoR (Version of Record)

Rights holder

© The authors

Publisher statement

This is an Open Access Article. It is published by Elsevier under the Creative Commons Attribution 4.0 Unported Licence (CC BY). Full details of this licence are available at: http://creativecommons.org/licenses/by/4.0/

Acceptance date

12/11/2017

Publication date

2017-11-13

Copyright date

2018

ISSN

1532-0464

eISSN

1532-0480

Language

en

Depositor

Deposit date: 1 December 2020