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While there is an extensive and established history of research that demonstrates the unfortunate capacity of exam room computing and electronic health records (EHRs) to negatively impact provider-patient communication and interaction, recent trends in exam room computing are promising in that there may be an opportunity for the EHR to improve patient engagement. The logical evolution of this research is to flip the narrative to understand strategies for using exam room computing as a mediator or facilitator of provider-patient communication and interaction, rather than simply establishing ways to mitigate the documented barriers. Panelists will present and discuss their latest research and experiences that may contribute to the evolution of using exam room computing as a tool to enhance provider-patient communication and interaction. We will also discuss how a thoughtful exam room design with patient-centered exam room computing technologies and practices may positively impact specific human factors, safety, and bias outcomes.

This practice-oriented paper presents a human-centered design (HCD) framework that we developed to perform a comprehensive evaluation of a new health information technology (HIT) system under development, intended to replace a legacy system. The Department of Veterans Affairs (VA) Veteran Crisis Line (VCL) program provides a vital service in crisis intervention and suicide prevention. VCL staff rely on a Customer Relationship Management (CRM) legacy system, Medora. VCL intended to replace Medora with Microsoft Dynamics 365 (D365) CRM system. Due to wide-spread criticism of D365, the VA Human Factors Engineering (HFE) team engaged in a multi-study, mixed-method HCD evaluation to investigate the legacy system and intended replacement in terms of ability to support VCL staff needs. The HCD framework we developed to perform this evaluation may be adapted for other large-scale HIT transitions and may provide human factors practitioners with guidance to make evidence-based decisions to support (or abandon) such transitions.

Over the last 15 years, healthcare delivery has experienced enormous changes across every aspect of clinical care, both for participants in it and affiliated stakeholders. The plethora and breadth of these changes and ongoing struggles with their incorporation into the work of healthcare begs the question: In 2035, what emerging innovations and considerations will we wish we had prepared for with regard to human factors engineering research, technology development, and system redesign efforts? Panelists and co-chairs have deep experience with steering, and being impacted by, innovations in information technology in healthcare. The panelists represent diverse academic, clinical, government contract research and development, and small entrepreneurial business. Perhaps the biggest benefit of this session will be the explicit inclusion of the audience in brainstorming and discussion activities, which will be facilitated digitally and verbally during the session and shared afterwards electronically with participants.

Provider burnout has reached epidemic levels, especially with primary care-oriented specialties such as Family Medicine. Guided by a sociotechnical systems perspective, we investigated contributing burnout factors that relate to the electronic health record (EHR) and clinical workflow in an academic healthcare institution. We conducted semi-structured interviews with 10 family medicine and geriatrics providers and administered EHR usability and workflow integration surveys. Findings are organized around recurrent, overarching themes: (1) Clinic Workflow, (2) Documentation, (3) EHR Workflow and Usability, (4) Patient Complexity, (5) Staffing, and (6) Technical Issues. The most consistent finding across all provider interviews was poor EHR usability as a contributing factor to burnout; especially the number of clicks needed to complete EHR tasks. This finding is supported by low usability and workflow integration survey ratings. Using a sociotechnical systems framework, we demonstrate social, technological, and environmental contributors to burnout and discuss potential interventions to mitigate these contributing factors.

Given the substantial increase in interest and activity in the virtual care space, the Department of Veterans Affairs (VA) is making a concerted effort to increase opportunities for Veterans to adopt virtual care applications. We investigated Veteran attitudes, interests, and needs for virtual care applications, including privacy considerations and specific types of data they would be comfortable sharing with their providers through various Veteran-facing tools. We administered a 28-item questionnaire to 40 Veterans and performed follow-up interviews with a subset of nine Veterans. Study results revealed broad support by Veterans for using virtual care applications, including wearable devices, for sharing all types of health information with their providers. Further, Veterans expressed a desire for consolidation across VA-provided virtual care tools. Our findings will inform a strategy for Veteran-facing tools. Other health care systems may be interested in exploring these topics, based on our study results.

The Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA) was interested in determining how mobile tablets may be perceived by clinicians for use in clinical settings. Therefore, we conducted an evaluation to assess how performance might differ between two devices and to gather feedback on device use. We conducted a within-subject comparison with 32 clinicians involving a usability test and two questionnaires. Qualitative data was organized around eight themes: facilitators and barriers to tablet use, observations of physical use, device specific advantages and disadvantages, and the Patient Viewer mobile application. Clinicians envisioned many facilitators to tablet use, but also voiced some concerns. Participants rated one device significantly better than the other for questionnaire items related to ‘Access and Efficiency’, ‘Introduction into the Clinical Environment’, ‘Usability and Usefulness’, and ‘Desire to Use’. Results can be used by mobile health app developers, healthcare organizations considering device purchases, and researchers conducting studies on tablets to inform respective work.

The coordination of site visits to execute human factors methods, such as onsite usability tests, interviews, or observations, in clinical settings requires a high level of management to attain successful data collection outcomes. Members of the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Human Factors Engineering (HFE) team occasionally visit VHA medical centers or outpatient clinics to complete our work. We have developed a site visit checklist as a practice innovation to facilitate logistical coordination when gathering data onsite. This Practice-Oriented paper includes the full checklist, as well as discussion of its use to enable other groups to benefit from lessons we have learned in conducting onsite work in health care settings.

This paper reports the results of a literature review of health care organizations that have transitioned from one electronic health record (EHR) to another. Ten different EHR to EHR transitions are documented in the academic literature. In eight of the 10 transitions, the health care organization transitioned to Epic, a commercial EHR which is dominating the market for large and medium hospitals and health care systems. The focus of the articles reviewed falls into two main categories: (1) data migration from the old to new EHR and (2) implementation of the new EHR as it relates to patient safety, provider satisfaction, and other measures pre-and post-transition. Several conclusions and recommendations are derived from this review of the literature, which may be informative for healthcare organizations preparing to replace an existing EHR. These recommendations are likely broadly relevant to EHR to EHR transitions, regardless of the new EHR vendor.

Although numerous healthcare organizations have transitioned from one electronic health record (EHR) to another or are currently planning a transition, there are few documented artifacts, such as published studies or operationalizable resources, that offer guidance on such transitions. This panel seeks to begin a conversation about human factors considerations in EHR transitions from a legacy system. Panel members will discuss current literature and research on the topic as well as experiences with and lessons learned from transitions within their organizations. Panel discussion can be expected to identify new research opportunities, needed resources, and guidance for EHR vendors or healthcare facilities in the midst of or preparing for an EHR transition. Panelists will also lay out systemic issues that need to be addressed at the national policy and regulatory level. This topic is relevant not only to full-scale EHR transitions, but also has applicability for significant EHR version changes.

Wearable heart rate (HR) monitors typically implement photoplethysmography (PPG) technology and are used in research as an alternative to electrocardiogram (ECG). However, questions surrounding the accuracy of PPG technology exist. To provide an answer regarding the question of accuracy, we conducted a study to compare average HR readings of two different HR technologies (PPG vs. ECG) after an interval style cardio-based workout. A total of 30 trials were conducted and average HR readings from the two HR technologies were compared using an ANOVA. Results revealed no significant difference between the two technologies. However, when HR reached around 155-160 beats per minute, a difference of +/− 5 beats per minute was observed between the two technologies with PPG HR readings being less than ECG. As a result, future research could consider the wearable PPG HR technology as accurate, but with certain experimental design implications.

Previous studies have evaluated the effectiveness of high fidelity patient simulators (HFPS) on nursing training. However, a gap exists on the effects of role assignment in multiple-student simulation scenarios. This study explored the effects of role assignment on self-efficacy development in baccalaureate-level nursing students. Using a researcher-developed tool, based upon a previously developed and utilized tool to fit the simulation scenario, the effects of role assignment were determined. Role assignment was found to have a significant effect on self-efficacy development. Furthermore, roles that require the participant to be more involved with the simulation scenario yielded more confident scores than roles that did not require the participant to be as involved. With this study, future multi-student simulation scenarios can be adjusted knowing the impact different roles can have on self-efficacy development.

Training can be expensive, dangerous, or impractical for certain situations. Virtual reality (VR) technology could be utilized to reduce the negative aspects of real-life training and the consequences incurred from inadequate training. However, for VR to be an effective training method, it must reflect reality to a certain extent. We measured task performance and situation awareness for parking situations with 15 participants in a real-world environment, and in a virtual environment using a VR headset and a flat screen computer monitor separately. Results revealed no significant difference in driver situation awareness between the reality, VR, and flat screen conditions. Performance in terms of task time was significantly less with the reality condition compared to the others. Therefore, the VR device was not equivalent to the real-world environment for training purposes. We discuss ways in which improvements to the VR training condition may increase the effectiveness of VR-based training.

This practice-oriented paper provides a collection of design principles that are specific to certain functions within the electronic health record (EHR). Design principles for EHRs tend to be broad rules of thumb rather than specific and actionable because the relevant literature is organized by specific EHR functions. That is, a good amount of research has been conducted on specific functions, rather than EHRs as a whole. Based on the relevant literature, we provide design principles with underlying rationale for progress notes, problem list, consults, clinical reminders, clinical decision support, medication list, medication alerts, and medication reconciliation. This paper is meant to offer a collection of practical guidelines for designers, grounded in the academic literature, that are more actionable than broad usability heuristics. Future work should include refinement of these principles through systematic literature review and the inclusion of additional EHR functions.

This study tested the effects of listening to fast vocal music, fast instrumental music, and no music on nine runners’ distance, average speed, average and maximum heart rate, stride length, and perceived exertion. The data collected during this study revealed music had an effect on maximum heart rate, perceived body tiredness, and perceived mood. This study supports the following conclusions: (1) to lower one’s maximum heart rate, one should listen to instrumental music rather than vocal music; and (2) to reduce the feeling of tiredness while running, one should listen to instrumental music rather than no music. The study also demonstrated that listening to vocal music rather than instrumental music improved runners’ moods. Further research should be conducted to investigate other factors and trends and their potential application to running performance.

With an increase in the number of nursing students and the limited number of open clinical positions, high-fidelity patient simulators (HFPS) have become the new norm. Multiple studies have evaluated HFPS effectiveness and several suggest that HFPS does has an effect on critical thinking. This study intends to provide data to support that suggestion. In addition, this study was designed to identify a possible correlation between role assignment and improvements in critical thinking after completion of a HFPS scenario. Analysis revealed that role assignment, for most of the roles, did have a statistically significant effect on the post-simulation critical thinking assessment scores. The relationship between role assignments and HFPS scenario outcomes (such as critical thinking), as well as the nature of the correlation, may help scenario developers better understand how critical thinking improvement can be affected by the involvement of the participant based on the roles assigned to them.

Medication management is a complex and mentally demanding endeavor performed by multiple individuals in diverse settings and at variable points in time. Achieving the goal of safe care delivery with optimized patient outcomes requires ongoing communication, coordination, and interaction between an array of technologies and roles across the health care continuum. Human factors principles and methods have the potential to substantially improve patient safety throughout this high-risk cycle. The purpose of this interactive discussion panel is to explore the medication management process from a sociotechnical perspective to identify specific challenges and vulnerabilities, and recommend strategies that leverage human factors processes and design principles to efficiently and effectively address safety critical issues.

Although much research has been conducted on the impact of the electronic health record (EHR) and health information technology (HIT) on provider-patient interaction, challenges persist on how to effectively integrate these tools into healthcare environments, while maintaining patient-centered care. Panelists will present and discuss their experience relating to: the introduction of new technology and how it changes the nature of work; the positive impact of greater focus on the patient; the nature of interruptions and strategies to reduce their negative impact; enhancing the workflow of medication ordering; and designing collaborative spaces considering all relevant stakeholders (patient care team, patients, family members). These topics represent some of the latest human factors research and design trends with a common goal: advancing the design of the modern healthcare environment, with consideration of the additional complexity introduced by evolutionary changes in clinical information systems and HIT.

This paper describes an effort to design and evaluate persuasive educational materials for colorectal cancer (CRC) screening. Although CRC screening is highly effective, screening rates in the US remain low. Educational materials represent one strategy for educating patients about screening options and increasing openness to screening. We developed a one-page brochure, leveraging factual information from the Centers for Disease Control and Prevention (CDC) and national guidelines, and strategies for persuasion from the human factors and behavioral economics literatures. We evaluated the resulting brochure with adults over the age of 50. Findings suggest that the educational brochure increases knowledge of CRC and screening options, and increases openness to screening. Furthermore, no significant difference was found between the new one-page brochure and an existing multi-page Screen for Life brochure recommended by the CDC. We interpret these findings as indication that the more practical and potentially less intimidating one-page brochure is as effective as the existing multi-page Screen for Life brochure.

Patient safety issues continue to be prevalent in delivering care with the electronic health record (EHR) and other health information technology (HIT) tools. Defining the unit of analysis for the study of clinical information systems is important based on the focus of the research. This study applies a conceptual framework with three levels of units of analysis for human-computer interaction (HCI) to identify and guide investigations at each level. Ethnographic observations and semi-structured, key-informant interviews were conducted with 40 healthcare workers across five primary care clinics, nine specialty clinics, and one inpatient ward at a tertiary-care Veterans Affairs Medical Center (VAMC). Two researchers recorded the interactions and interview responses of 40 healthcare workers related to their work with computerized consultations, clinical documentation, and the EHR in general. Patient safety issues from these data were categorized using three different units of analysis: EHR interface-, team coordination / workflow-, and organizational-levels. A total of 30 patient safety issues were identified; 17 emerged from the observation and interview data on computerized consults, 10 from the data on clinical documentation, and 3 were related to the EHR in general. Patient safety issues were organized by level of unit of analysis and mapped to specific methods that could be used for further investigation. Relevant concepts are discussed to help guide investigations at each level.

This article reports redesign strategies identified to create a Web-based user-interface for the Self-management TO Prevent (STOP) Stroke Tool. Members of a Stroke Quality Improvement Network (N = 12) viewed a visualization video of a proposed prototype and provided feedback on implementation barriers/facilitators. Stroke-care providers (N = 10) tested the Web-based prototype in think-aloud sessions of simulated clinic visits. Participants’ dialogues were coded into themes. Access to comprehensive information and the automated features/systematized processes were the primary accessibility and usability facilitator themes. The need for training, time to complete the tool, and computer-centric care were identified as possible usability barriers. Patient accountability, reminders for best practice, goal-focused care, and communication/counseling themes indicate that the STOP Stroke Tool supports the paradigm of patient-centered care. The STOP Stroke Tool was found to prompt clinicians on secondary stroke-prevention clinical-practice guidelines, facilitate comprehensive documentation of evidence-based care, and support clinicians in providing patient-centered care through the shared decision-making process that occurred while using the action-planning/goal-setting feature of the tool.

This article identifies sources of variation in clinical workflow and implications for the design and implementation of electronic clinical decision support. Sources of variation in workflow were identified via rapid ethnographic observation, focus groups, and interviews across a total of eight medical centers in both the Veterans Health Administration and academic medical centers nationally regarded as leaders in developing and using clinical decision support. Data were reviewed for types of variability within the social and technical subsystems and the external environment as described in the sociotechnical systems theory. Two researchers independently identified examples of variation and their sources, and then met with each other to discuss them until consensus was reached. Sources of variation were categorized as environmental (clinic staffing and clinic pace), social (perception of health information technology and real-time use with patients), or technical (computer access and information access). Examples of sources of variation within each of the categories are described and discussed in terms of impact on clinical workflow. As technologies are implemented, barriers to use become visible over time as users struggle to adapt workflow and work practices to accommodate new technologies. Each source of variability identified has implications for the effective design and implementation of useful health information technology. Accommodating moderate variability in workflow is anticipated to avoid brittle and inflexible workflow designs, while also avoiding unnecessary complexity for implementers and users.

With the United States national goal and incentive program to transition from paper to electronic health records (EHRs), healthcare organizations are increasingly implementing EHRs and other related health information technology (IT). However, in institutions which have long adopted these computerized systems, such as the Veterans Health Administration, healthcare workers continue to rely on paper to complete their work. Furthermore, insufficient EHR design also results in computer-based workarounds. Using direct observation with opportunistic interviewing, we investigated the use of paper- and computerbased workarounds to the EHR with a multi-site study of 54 healthcare workers, including primary care providers, nurses, and other healthcare staff. Our analysis revealed several paper- and computer-based workarounds to the VA’s EHR. These workarounds, including clinician-designed information tools, provide evidence for how to enhance the design of the EHR to better support the needs of clinicians.

The aim of this investigation was to assess helpful and challenging aspects of electronic health information with respect to clinical workflow and identify a set of characteristics that support patient care processes. We conducted 20 semi-structured interviews at a Veterans Affairs Medical Center, with a fully implemented electronic health record (EHR), and elicited positive and negative examples of how information technology (IT) affects the work of healthcare employees. Responses naturally shed light on information characteristics that aid work processes. We performed a secondary analysis on interview data and inductively identified characteristics of electronic information that support healthcare workflow. Participants provided 199 examples of how electronic information affects workflow. Seventeen characteristics emerged along with four primary domains: trustworthy and reliable; ubiquitous; effectively displayed; and adaptable to work demands. Each characteristic may be used to help evaluate health information technology pre- and post-implementation. Results provide several strategies to improve EHR design and implementation to better support healthcare workflow.

While the potential benefits of computerized provider order entry (CPOE) are well recognized, little is known about how prescribers have integrated electronic medication ordering into other aspects of patient care. As part of a larger investigation of computerized medication alerts, we observed and opportunistically interviewed 20 primary care prescribers at a major Veterans Affairs Medical Center (VAMC). Participants were recruited from each of the VAMC's 5 primary care clinics and included physicians, nurse practitioners, and clinical pharmacists. Prescribers were observed as they ordered mediations via the CPOE system during routine patient care. In total, observations included 91 routine patient encounters across 66.5 hrs of observation. This paper provides illustrative case examples of how prescribers have integrated CPOE into medication decision-making processes and other patient care tasks. Results demonstrate that CPOE workflow varies widely among prescribers. In addition, results indicate that there are trade-offs associated with using CPOE with the patient in the exam room versus outside of the exam room. Findings may have implications for provider-patient relationships, workflow efficiency, and medication safety, and may ultimately enhance the effectiveness of CPOE in primary care.

We developed a User-Testing Database to be able to process a greater amount of user data, from multiple sources of data, at a much finer level of granularity, and to be able to aid in a more sophisticated analysis, including specific queries of usability data than a typical “manual”-based usability analysis. In this paper, we demonstrate our User-Testing Database as applied to a usability assessment of the Veterans Affairs (VA) My HealtheVet personal health record. The usability test included 24 Veterans who completed a series of scenarios in the usability lab at a Midwest Veterans Affairs Medical Center (VAMC). The User-Testing Database facilitated reduction of data gathered from video review, facilitator notes, and debrief notes into 1160 observations that were sorted into conceptual bins and summarized for the designers of the personal health record. From creation of the database to completion of the reports took four months and did not require extensive knowledge of qualitative analysis techniques. We argue a User-Testing Database can allow other usability studies to increase the number of participants and the granularity of the data without prohibitively increasing the amount of time and experience required to process the data gathered.

Electronic health record (EHR) systems and health information technology (IT) hold unrealized potential for improving the quality, continuity, and safety of medical care; they can also introduce new gaps in care and present unique challenges for healthcare workers. We conducted 14 key informant, semi-structured interviews at a large Veterans Affairs Medical Center and asked healthcare employees why paper use persists despite a fully implemented EHR. In this investigation, we performed a secondary analysis on interview data to identify characteristics of information technology (IT) that are important to support healthcare workflow. As a result of this study, 17 distinct information characteristics emerged; in this document, we provide detail on five characteristics that were often cited as desirable for workflow but insufficiently supported by health IT: 1) customizable, 2) prioritized, 3) trendable, 4) locatable, and 5) accessible. Results from this study reveal key electronic information characteristics for healthcare workflow and have implications for patient safety and future health IT designs.

Computerized medication alerts (e.g., drug-drug interactions, drug-allergy interactions), which are intended to protect patient safety, need to match the mental models of medication prescribers in order to aid medication ordering. To maximally protect patient safety, the programmer mental model, system image, and prescriber mental model should work seamlessly together to fully support prescriber decision-making. In this study, we examined prescribing processes in the context of routine patient care to understand how the design of medication alerts can be enhanced for prescribers. We shadowed prescribers, including physicians, pharmacists, and nurse practitioners, across five outpatient primary care clinics at a large Veterans Affairs Medical Center (VAMC). In addition, prescribers were opportunistically interviewed as they ordered mediations via a computerized order entry system and resolved any subsequent medication alerts. This investigation is one of the few to examine medication alerts by directly observing prescribers during patient care. Altogether, 191 medication alerts occurred across 63.5 total hrs of observation, 19 prescribers, and 86 patients during routine patient care tasks. Results reveal problematic system images and mismatches between programmer and prescriber mental models. Findings can help inform medication alert redesigns, which may promote safer, more effective prescribing practices.

Healthcare organizations are increasingly implementing electronic medical records (EMRs) and other related health information technology (IT). Even in institutions which have long adopted these computerized systems, there are still instances where employees rely on paper to complete their work. The use of paper suggests that parts of the EMR may not be sufficiently designed to support clinicians and their work processes. To understand the use of paper-based alternatives, we conducted 14 key-informant interviews in a large Veterans Affairs Medical Center (VAMC), with a fully implemented EMR. We found nine distinct categories of paper-based workarounds to the use of the EMR. In several cases, paper served as an important tool and assisted healthcare employees in their work. In other cases, paper use circumvented the intended EMR design, introduced potential gaps in documentation, and generated possible paths to medical error. We discuss implications of these findings for EMR design and implementation.

OBJECTIVE: We examined the willingness and ability of general aviation pilots to execute steep approaches in low-visibility conditions into nontowered airports. BACKGROUND: Executing steep approaches in poor weather is required for a proposed Small Aircraft Transportation System (SATS) that consists of small aircraft flying direct routes to a network of regional airports. METHOD: Across two experiments, 17 pilots rated for Instrument Flight Rules at George Mason University or Virginia Tech flew a Cessna 172R simulator into Blacksburg, Virginia. Pilots were familiarized with the simulator and asked to fly approaches with either a 200- or 400-foot ceiling (at approach angles of 3 degrees, 5 degrees, and 7 degrees in the first experiment, 3 degrees and 6 degrees in the second). Pilots rated subjective workload and the simulator recorded flight parameters for each set of approaches. RESULTS: Approaches with a 5 degree approach angle produced safe landings with minimal deviations from normal descent control configurations and were rated as having a moderate level of workload. Approaches with 6 degree and 7 degree approach angles produced safe landings but high workload ratings. Pilots reduced power to control the speed of descent and flew the aircraft slightly above the glide path to gain time to control the landing. CONCLUSION: Although the 6 degree and 7 degree approaches may not be practical for routine approaches, they may be achievable in the event of an emergency. APPLICATION: Further work using other aircraft flying under a wider variety of conditions is needed before implementing SATS-type flights into airports intended to supplant or complement commercial operations in larger airports. Language: en

Computerized clinical reminders (CRs) can improve compliance with evidence-based practices in preventive care and chronic disease management. However, observational research is needed to explain the known variability in the use of CRs. We conducted ethnographic observations of nurses and providers using CRs in outpatient primary care clinics for two days in each of four geographically distributed Veterans Administration (VA) medical centers. We found that use of CRs was impeded by (1) lack of coordination between nurses and providers, (2) using the reminders while not with the patient, impairing data acquisition and/or implementation of recommended actions, (3) workload, (4) lack of CR flexibility, and (5) poor interface usability. We discuss implications of these findings for CR system design and provide recommendations for redesign to facilitate the effective use of CRs.

Previous research on personal health records (PHRs) has focused on applications that are “tethered” to a specific electronic health record (EHR). However, there is a gap in research on the usability of unaffiliated, independent PHRs, as well as research on college-aged PHR users. Therefore, we performed a comparative usability study with 18 college-aged participants on three popular, freely available, independent PHRs. We chose a within-subject design to allow for comparative feedback from each participant in the post-experiment interview. In order to control for a learning effect between PHRs potentially affecting the usability performance measures, the order that participants used the PHRs was randomized across participants. We used analysis of variance (ANOVA) to determine if there were statistically significant differences in the usability measures. Based on variability of PHR use and design reported in previous research, we hypothesized that there would be a significant difference for each of the measures previously described and that one PHR would be the most usable product based on these measures. This hypothesis is based on the PHR’s extensive resources and company history. Participants completed the same six tasks in three different PHRs. Dependent variables included task time, mouse movement, mouse clicks, keystrokes, errors, and user satisfaction ratings based on the Computer System Usability Questionnaire (CSUQ). Analysis of variance (ANOVA) was used to determine the significance in the difference of the means for each dependent variable. Results showed statistically significant differences in CSUQ survey categories, errors, and keystrokes. Results supported one of the three PHRs as having better usability than its tested counterparts. While the initial purpose of this study was comparative usability testing of PHRs for college-aged students, the study provided other insights as well. Similar to other usability studies found in the literature review, the study used multiple methods, including objective task metrics, a survey, and an interview to solicit feedback on the systems. This provides a new addition to the literature in that it analyzes the usability of a system with a new user group and completed a comparative analysis of three leading Web-based, untethered PHRs. The initial hypothesis that there would be a significant difference in usability for each of the dependent measures and that one PHR would have better usability based on these measures was partially supported by the results. While not all of the criteria had statistically significant results for the three different systems, such as task time, mouse movement, mouse clicks, and interface quality, many of the measures did have significant differences in their means, and one of the PHRs had the best results in the majority of metrics analyzed. Though one PHR seemed to more usable than the other systems, it does not imply that this PHR is without error. There are still improvements that could be made to enhance the usability of the system. For example, several participants commented on how they liked the interface of one of the competing PHRs. Several participants also commented that some of the drop-downs limit the options and are not representative of the information they were trying to enter. Expanded dropdowns or typing options could be added to improve this. As found in the a different study, there are still barriers to the adoption of the PHR that was found to be most usable. Using the survey and open-ended survey results as a guide to improvement, the PHR that was found to be most usable in our study has the potential to further improve its usability.

A future trend is the of adoption of a multiscreen and multiple device approach to cope with distractions and multiple tasks. Although this may seem counterintuitive, more screens and possibly more devices may help focus one’s attention rather than serve as a distraction, making multiple tasks viewable at a glance across multiple device screens (Thompson, 2014). Potential benefits of multiscreen and multiple device environments were assessed using three different computing environments. A single factor, within-subject study was conducted with 18 engineering students in a laboratory experiment. Three levels for the computing environment factor included one with a desktop computer with a single monitor (control, condition A); one with a desktop with dual monitors, as well as a single tablet computer (condition B); and one with a desktop with a single monitor, as well as two tablet computers (condition C). There was no statistically significant difference in efficiency when completing scenarios for the three computing environments. However, a dual monitor desktop with a single tablet computer (B) was the ideal computing environment for the information-rich engineering problem given to participants, supported by significantly fewer errors compared to condition C and significantly higher usability ratings compared to conditions A and C. A single desktop monitor with two tablet computers (C) did not provide any advantage compared to a single desktop monitor (A). A dual monitor desktop with a single tablet computer (condition B) was the ideal computing environment for the “information-rich” engineering problem given to participants. This is supported by converging evidence from the dependent measures as well as qualitative debrief interviews. A single desktop monitor with two tablet computers (condition C) did not provide any advantage compared to a single desktop monitor (condition A). Overall, these findings provide only marginal support for the concept we set out to investigate, which was the notion that more screens and possibly more devices may help focus one’s attention rather than serve as a distraction, making multiple tasks viewable at a glance across multiple device screens (Thompson, 2014). The finding of a performance and usability advantage of the dual monitors in condition B is consistent with previous studies (Anderson et al., 2004; Poder et al., 2011; Russell & Wong, 2005). A key difference in our study is that we provided a tablet computer in addition to the dual monitors. However, the debrief interviews were mixed as to the usefulness of the third screen provided by the tablet; some participants thought it was not helpful whereas other did find it useful. The complete lack of performance, workload, and usability differences between condition C (single monitor and two tablet computers) and condition A (single monitor) does not support the notion that a multiscreen environment can help focus one’s attention. Indeed, some participants noted that using multiple screens provided by the tablet computer(s) was distracting. Others noted that while they did not hinder their tasks, they did not help. Based on these results, we recommend a computing work environment with dual screen monitors, with an optional tablet computer, for complex and information-rich computing tasks.

Total quality management is a team-based approach to the improvement of processes for the continual satisfaction of customers. Thus, three core values are common to TQM efforts: continuous improvement, customer satisfaction and teamwork. There have been some broad attempts to quantify the effects of continuous improvement, customer satisfaction and teamwork. However, we have argued previously that many TQM efforts start too late and end too soon. Starting late means that TQM is often not given strategic thought, for example in deciding strategically, which processes to improve. TQM often ends too soon in the sense that it stops at the process level and does not proceed to the human-machine interface (i.e., ergonomic) level. It is argued that participatory ergonomics, a staple method in macroergonomics, can benefit TQM efforts by bringing such efforts “down to” the ergonomic level. This paper presents our recent attempts to quantify the effects of participation.

This paper describes a project employing decision-centered design to develop a decision support application called the Screening & Surveillance App (SSA) to aid primary care providers in tracking and managing colorectal cancer (CRC) screening for their patients. This paper details the path from cognitive task analysis (CTA) to a decision support application. We conducted ethnographic observations and CTA interviews to identify common elements of clinical workflow across health systems and articulate decision requirements. We describe three design iterations that emerged over the course of CTA and software development. Findings from a beta test evaluating the SSA suggest that it saves time, increases accuracy in responding to CRC-related patient-specific questions, and is perceived to reduce workflow as compared to participants’ current electronic health records (EHR). Usability and usefulness ratings for the SSA as measured by the Health ITUES were above 4 on a 5-point scale where 5 was most positive.

This practice-oriented presentation describes several factors that contribute to the divide between applied research and operations for health information technology (HIT). Factors and corresponding recommendations were drawn from experiences working in both research and operations positions as human factors professionals within a large healthcare system, the Veterans Health Administration (VHA). We offer specific recommendations for addressing each of these factors to help reduce the gap. Although our findings and recommendations were derived from our VHA experience, we expect many of the lessons learned are relevant to other major healthcare organizations. Indeed, we strongly suspect that the factors presented represent fundamental differentiators between researchers and operational-based professionals. Understanding these differences and findings ways to bridge them is essential for advancing HIT.