Usability of Health Information Exchange User Interfaces during Simulated Medication Reconciliation
TimeThursday, April 152:45pm - 2:46pm EDT
Health information exchange (HIE) is the electronic sharing of medical records between health care institutions. One application of HIE is medication reconciliation, the practice of identifying and resolving differences among a patient’s medications. Despite its role in patient safety, clinicians do not reconcile medications as often as recommended (Almanasreh, Moles, & Chen, 2016). By collecting and displaying medication information and related records from different health care systems, HIE can help clinicians reconcile medications more accurately and efficiently (Menachemi, Rahurkar, Harle, & Vest, 2018). Despite this opportunity, research indicates that HIE is generally underused (Devine et al., 2017; Mello, Adler-Milstein, Ding, & Savage, 2018). Reported barriers to HIE use include inadequate usability of the user interface (Everson, 2017; Rudin, Motala, Goldzweig, & Shekelle, 2014; Rudin, Volk, Simon, & Bates, 2011) and problems with information completeness and relevance (Eden et al., 2016).
Our study fills a gap in the literature on HIE-supported medication reconciliation by exploring both HIE interface usability and HIE information utility. Our study’s objective was to assess how well HIE currently supports medication reconciliation by testing the ease of use, perceived utility, and effectiveness of three HIE technologies in a simulated clinical setting.
We studied three HIE interfaces used in the U.S. Department of Veterans Affairs (VA) health care system. One interface was embedded in the electronic health record (EHR), and the other two interfaces were separate Web-based applications with access to data sources outside the VA. From email lists provided by study coordinators, we recruited clinicians (physicians, pharmacists, and nurse practitioners) from four VA facilities across the U.S. to participate in 40-minute usability sessions. The usability sessions were conducted on a desktop computer in a human-computer interaction research laboratory; participation occurred in person or via teleconference. While using the think-aloud technique, clinicians completed either one or two reconciliation tasks that were cross-institutional, time-limited, and randomly assigned.
We measured three outcomes: ease of use, perceived utility, and effectiveness. Clinicians rated ease of use and perceived utility using a validated instrument with seven-point Likert-scaled items (7=strongly agree; Lewis, Utesch, & Maher, 2015). We also counted the usability and content problems that participants encountered (Kushniruk & Borycki, 2015). To determine effectiveness, analysts measured task completion, defined as finding the correct doses for three specified medications.
Forty-four clinicians participated: 34 prescribers (23 physicians and 11 nurse practitioners from general medicine and 11 specialties) and 10 pharmacists. Previous exposure to the three interfaces was high; each had been used by at least 40 (91%) of the participants. Participants spent 71% of task time in the EHR and its HIE interface, which they also rated highest in ease of use and utility (ease of use mean [SD]= 5.0 [1.5] vs. 3.3 [1.4] and 3.3 [1.5] for the other two interfaces; utility 4.9 [1.4] vs. 3.4 [1.6] and 3.7 [1.5]). Regarding HIE effectiveness, only 50% of attempted reconciliation tasks were fully completed. Problems encountered frequently included unclear screen layout (80% of participants) and irrelevant data (77% of participants).
During simulated cross-institutional medication reconciliation tasks, clinicians rated their EHR and its HIE interface highest in ease of use and utility, although two alternative HIE interfaces offered additional relevant data. Barriers to using the other two interfaces included difficult navigation and uncertain data quality. Two specific strategies to address the issues encountered are as follows: (1) decrease navigation between local and HIE records, ideally co-presenting them, and (2) display key contextual data (metadata) for each record. An example of the former is to combine local and HIE data in sortable tables. An example of the latter is to display each record’s creation date, author, and source institution. Together, these strategies may increase HIE’s immediate usefulness during medication reconciliation.
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