Usability study of a novel collaborative health IT in a pediatric ICU
TimeThursday, April 152:46pm - 2:47pm EDT
Non-mandated technologies hold the promise of increasing health care quality by rendering care more patient-centered, collaborative, and team approach-driven (Pell et al., 2015; Prey et al., 2014). Large Customizable Interactive Monitor (LCIM), a non-mandated collaborative HIT, is a flat panel touch screen monitor that displays validated patient information from the EHR, including vital signs, laboratory results, medications, X-rays, and interventions.
The present study addresses gaps in postadoption research on collaborative inpatient HIT systems in pediatric settings. With the focus on the inpatient pediatric population, we identify the usability issues experienced by doctors and patients’ family while using LCIM. Filling these gaps produces scientific knowledge about how providers and patients’ family member perceive LCIM technology’s usability.
We used qualitative semi-structured, in-person interviews to collect data from critical care providers, including physicians, pediatric nurse practitioners, and patients’ parents in the PICU. We collected contextual data on clinicians’ and parents’ use of the LCIM. We conducted all the analyses using anonymous data with approval from the hospital’s institutional review board.
The study was conducted in a Midwestern children’s hospital PICU consisting of a 72-bed unit with approximately 3000 admissions per year. Wall-mounted LCIMs were installed in each PICU patient room at the time of the implementation of a new commercial EHR.
We used an inductive thematic analysis approach for the analysis of the qualitative interview data. All interviews were audiotaped and transcribed verbatim for analysis. Two coders conducted the main thematic coding process with a third independent coder serving as a judge to adjudicate any disagreements.
A total of 33 parents and 36 providers participated in this study. We grouped our findings into positive and negative perceptions based on participants' responses, where negative responses were indicative of undesirable features of the LCIM and usability issues faced by the users (doctors and families). Participants expressed more negative perceptions of LCIM.
The themes were surrounded around data display characteristics, intuition, physical properties, features supporting or opposing the user's mental model, and technical problems. Table 1 illustrates all specific issues (positive and negative) with the definitions that emerged from the analysis. We listed all major responses/issues that emerged from the data. Often responses from families and doctors were contradicting each other. For instance, some parents and the majority of doctors thought that LCIM was intuitive. Whereas other parents thought it is not.
The touch screen LCIM was implemented in each room with no password. Users, both doctors and parents, though they have effortless access to entire data with no navigation or additional cognitive demand related to the login process.
“They are [access to data] certainly easier than logging into Epic, especially when nurses need to document on their computers in the room, and I think because they update themselves real-time." (doctor)
"I like that I can see what is going on with my kids like I said, his blood gases, and his blood cell count, and things like that. That is to me, I watch those numbers because I know when the infection is coming or, you know, stuff like that, and that's very reassuring to me to be able to look at that and say, okay, that number's okay. There's no infection, stop worrying, fever's normal. As I said, it's a very reassuring tool." ( parent)
The design features, especially visual illustrations of image data and trends, made it more attractive, aligned with users’ mental models, and understandable for some users.
“Everything is nicely graphically represented so you’re not giving me a number in time, we’re following the trends. Is there anything that looks abnormal? Oh, what happened here?” (doctor)
“Yeah, and they were actually able to see in his lungs a lot better when they were able to darken the x-ray, so that’s really neat because with a regular x-ray you can’t do that.” (parent)
The majority of parents, as well as doctors, thought it is intuitive and easy to use.
“Oh I think it’s super easy because you just touch something, and it comes up. It’s kind of like an iPad on the screen.” ( doctor)
“For me it’s easy to use because it makes sense. I would think that, so for me it makes sense because everything is organized.” (parent)
However, few participants found LCIM to be not intuitive enough and require more training to better use it.
"if I wanted to go in and look at a consult's note while I was in the room to see if they had left their note yet, I don't know if that information is there. I'm guessing it probably is, but I have no idea how to access that. So, in terms of reading notes and things left by consultant teams, I don't know if that information is there." (doctor)
Our findings reveal a range of insights that show positive and negative impact of LCIM in a pediatric setting on doctors and patient families. The finding of this study can inform the design and implementation of future collaborative technologies.
Pell, J. M., Mancuso, M., Limon, S., Oman, K., & Lin, C. T. (2015). Patient access to electronic health records during hospitalization. JAMA Intern Med, 175, 856-858.
Prey, J. E., Woollen, J., Wilcox, L., Sackeim, A. D., Hripcsak, G., Bakken, S., et al. (2014). Patient engagement in the inpatient setting: A systematic review. J Am Med Inform Assoc, 21, 742-750.