Clinicians' user experience with health information exchange technologies during simulated medication reconciliation

Patel H, Savoy A, Sanchez S, Traylor MH, Nguyen KA, Boockvar KS, Fan VS, Locke ER, Gibson B, Mixon AS, Byerly SH, Haggstrom DA, Damush TM, Weiner M, Russ AL. Clinicians' user experience with health information exchange technologies during simulated medication reconciliation. Human Factors in Healthcare. 2024 Apr 16; 100073, doi.org/10.1016/j.hfh.2024.100073.

Related HSR&D Project(s)

• IIR 16-297 – A Human Factors Investigation of Health Information Exchange: Tools to Support Providers' Coordination of Medications

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Abstract:

Background Health information exchange (HIE), the electronic sharing of medical records between health care institutions, may increase patient safety. However, reported barriers to clinicians' use of HIE include poor system usability and information quality. Through simulated medication reconciliation tasks, our objective was to characterize clinicians' user experience with HIE technologies, and to identify requirements for future HIE technologies from clinicians' current use patterns. Methods Our simulation-based observational study included three successive generations of HIE technologies used in the U.S. Department of Veterans Affairs (VA) health care system: Computerized Patient Record System (CPRS); VistA Web; and Joint Longitudinal Viewer (JLV). While using a think-aloud technique, participants attempted two randomly assigned, time-limited medication reconciliation tasks using any of these technologies. Tasks followed from clinical scenarios that varied on the types of cues about HIE data availability. After tasks, participants used the UMUX-Lite instrument to rate each technology's ease of use and utility (each range 1-7; 7 = strongly agree). To identify design-related barriers, we coded and interpreted usability and content problems that participants encountered. To ease coding, we used error frequency to indicate error severity. Results Forty-four clinicians, spanning 21 specialists, participated from four VA medical centers: 23 physicians, 11 nurse practitioners, and 10 pharmacists. Overall, participant-rated ease of use and utility (mean [SD]) were 4.0 (1.7)-a point-estimate grade of D ("Fair")- and 4.0 (1.6), respectively. Participants spent 71% of task time in CPRS, which also ranked highest in ease of use and utility (p < .001). Across technologies, frequent user-experience problems included unclear screen layout (35 [80%] participants), difficult navigation (35 [80%]), and task-irrelevant data (34 [77%]). Notable features included preformatted reports; table sorting methods; data-availability indicators; and filters for data sources, time periods, and keywords. Conclusion To improve clinicians' user experience and ease transitions to newer platforms, HIE technologies should 1) communicate data scope, 2) minimize clinicians' navigation steps, 3) summarize retrieved data, and 4) offer searching, sorting, and filtering. These strategies may increase HIE's usefulness for clinicians when reconciling patients' medications.