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With the increasing rate of diabetes diagnoses, more patients and healthcare providers are exchanging information. There is a need to understand these diabetes team coordination processes to help facilitate optimal patient care. However, prior to evaluating team coordination processes, it is essential to first define the members of the team. The purpose of this research is to use social network analysis tools to determine the most common and critical diabetes care team members from the practicing healthcare professional perspective. Using participant rankings and measures of centrality (in-degree and in-strength), it was found that the key roles include primary care providers, registered dietitians, registered nurses, pharmacists, endocrinologists, and social workers. The results of this work highlight the importance of coordinating multiple expertise roles and information flow pathways when enhancing diabetes care activities.

Over 48 million Americans are currently living with a chronic disease. To effectively manage chronic diseases, there is a need for interventions at multiple points in the care process, with integrated health information technology (HIT) systems to assist with information coordination for patients, caregivers, and providers. Systems engineering models can be useful for minimizing unintended consequences with HIT implementation; however, there are gaps in applying such models to precision medicine and chronic care management. The objective of this work was to review the key attributes of systems engineering models for chronic disease management and precision medicine applications. Several key attributes were selected to address: granularity, temporal dynamics, sociotechnical factors, chronic care applications, and HIT integration. The analysis found that the most difficult challenge is depicting granularity and temporal dynamics in systems engineering implementations so that they can still be easily applied by practitioners. Future work aims to determine appropriate systems engineering interventions and implementations that integrate information architecture, systems granularity, and event dynamics for longitudinal coordinated care activities.

Objective An electronic medication reconciliation tool was previously developed by another research team to aid provider-patient communication for medication reconciliation. To evaluate the usability of this tool, we integrated artificial safety probes into standard usability methods. The objective of this article is to describe this method of using safety probes, which enabled us to evaluate how well the tool supports users’ detection of medication discrepancies. Materials and methods We completed a mixed-method usability evaluation in a simulated setting with 30 participants: 20 healthcare professionals (HCPs) and 10 patients. We used factual scenarios but embedded three artificial safety probes: (1) a missing medication (i.e., omission); (2) an extraneous medication (i.e., commission); and (3) an inaccurate dose (i.e., dose discrepancy). We measured users’ detection of each probe to estimate the probability that a HCP or patient would detect these discrepancies. Additionally, we recorded participants’ detection of naturally occurring discrepancies. Results Each safety probe was detected by ≤50% of HCPs. Patients’ detection rates were generally higher. Estimates indicate that a HCP and patient, together, would detect 44.8% of these medication discrepancies. Additionally, HCPs and patients detected 25 and 45 naturally-occurring discrepancies, respectively. Discussion Overall, detection of medication discrepancies was low. Findings indicate that more advanced interface designs are warranted. Future research is needed on how technologies can be designed to better aid HCPs’ and patients’ detection of medication discrepancies. Conclusion This is one of the first studies to evaluate the usability of a collaborative medication reconciliation tool and assess HCPs’ and patients’ detection of medication discrepancies. Results demonstrate that embedded safety probes can enhance standard usability methods by measuring additional, clinically-focused usability outcomes. The novel safety probes we used may serve as an initial, standard set for future medication reconciliation research. More prevalent use of safety probes could strengthen usability research for a variety of health information technologies.

Medication errors in the ambulatory setting are common and contribute to significant morbidity and mortality. Given the Institute of Medicine’s recommendation of adopting a systems-based approach to improving medication safety, research has been conducted utilizing human factors and ergonomics conceptual frameworks, approaches, and methods to study pharmacies and pharmacists. This panel will focus on how human factors principles and models have been adapted for contexts where medications are managed. Individual projects address pediatric patients’ medication-related needs, over-the-counter medication safety for older adults, anticoagulation management, automated prescription tracking, and medication safety-related decision making by healthcare professionals. These studies span settings from community pharmacies to inpatient pharmacies to specialty clinics and patients’ homes. By presenting a sample of the growing body of human factors work in pharmacy, this panel will offer unique implications for human factors theory, methods, and application in this important domain.

Patient safety has been an area of intense attention and research across disciplines for nearly two decades, with medication safety being a key concern. Many community pharmacies have installed software programs with algorithms to detect and alert pharmacists of potentially harmful drug interactions. Despite the improvements that have been made in reducing medication errors by using these engineering interventions, there are information gaps in addressing broader contextual information related to patients’ health goals. Focusing on the role and work tasks of community pharmacists helps to address the usability issues that could arise if medication decision support tools expanded to include an increasing range of medication alerts. The authors’ goal is to improve alignment between healthcare professional needs and patient health goals, while recognizing the unique work demands and patient interaction opportunities of community pharmacists.

As the expansion and utilisation of community pharmacy systems increases, so does the risk for an adverse drug event to occur. In attempts to mitigate this risk, many community pharmacies implement health information technology (IT); however, there are challenges in integrating the wider systems components necessary for a successful implementation with minimal unintended consequences. The purpose of this paper is to introduce a Community Health Integration through Pharmacy Process and Ergonomics Redesign (CHIPPER) framework, which explores the multiple angles of health IT integration to support medication delivery processes in community pharmacy systems. Specifically, CHIPPER identifies the information flows that occur between different parts of the system (initiation, upstream, midstream and downstream) with varying end-users and tasks related to medication delivery processes. In addition to the justification and presentation of the CHIPPER model, this paper reviews several broad applications for CHIPPER and presents two example studies that demonstrate the CHIPPER framework. Practitioner Summary: Most medication delivery in the US occurs through outpatient-based community pharmacy practice. Community pharmacies are challenged by inconsistent and incomplete information flow and technology integration between providers, pharmacy practitioners and patients. This paper presents a framework for improved healthcare systems engineering analysis of pharmacy practice, with case study examples.

Background Web-based patient portals feature secure messaging systems that enable health care providers and patients to communicate information. However, little is known about the usability of these systems for clinical document sharing. Objective This article evaluates the usability of a secure messaging system for providers and patients in terms of its ability to support sharing of electronic clinical documents. Methods We conducted usability testing with providers and patients in a human–computer interaction laboratory at a Midwestern U.S. hospital. Providers sent a medication list document to a fictitious patient via secure messaging. Separately, patients retrieved the clinical document from a secure message and returned it to a fictitious provider. We collected use errors, task completion, task time, and satisfaction. Results Twenty-nine individuals participated: 19 providers (6 physicians, 6 registered nurses, and 7 pharmacists) and 10 patients. Among providers, 11 (58%) attached and sent the clinical document via secure messaging without requiring assistance, in a median (range) of 4.5 (1.8–12.7) minutes. No patients completed tasks without moderator assistance. Patients accessed the secure messaging system within 3.6 (1.2–15.0) minutes; retrieved the clinical document within 0.8 (0.5–5.7) minutes; and sent the attached clinical document in 6.3 (1.5–18.1) minutes. Although median satisfaction ratings were high, with 5.8 for providers and 6.0 for patients (scale, 0–7), we identified 36 different use errors. Physicians and pharmacists requested additional features to support care coordination via health information technology, while nurses requested features to support efficiency for their tasks. Conclusion This study examined the usability of clinical document sharing, a key feature of many secure messaging systems. Our results highlight similarities and differences between provider and patient end-user groups, which can inform secure messaging design to improve learnability and efficiency. The observations suggest recommendations for improving the technical aspects of secure messaging for clinical document sharing.

When faced with difficult budget restrictions, many university departments attempt to increase enrollment to offset costs. To appeal to high quality students who may be interested in a program, it is critical for a university department to provide information online in an easily accessible, aesthetically pleasing format that matches potential students’ goals and information needs. Our research team was tasked with helping [redacted] university’s Computer Graphics Technology (CGT) Master of Science (MS) program to improve their existing website. Through user-centered design and goal-directed design methodologies, we were able to evaluate the existing website for design flaws, gather user research to inform our conceptual redesign, and evaluate our redesign for usability and compatibility with users’ mental models. This paper outlines our process and concludes with design implications that other university departments can use to improve their own websites.

The result of a multi-year, multi-lab, interdisciplinary research project examining the impact of the introduction of robot-assisted surgical (RAS) technology into modern operating rooms, this presentation explores intra-corporeal RAS as a highly specialized, but not entirely unique working technique. Hundreds of hours of direct in-room observation, interviews with RAS surgeons at all levels of expertise from almost total novices to world-renowned experts have allowed the authors to recognize specific commonalities, particularly those dealing with changes in operator perspective, altered team roles, and coordination processes. In particular analogs between RAS, areal refueling, tower-crane construction work, and robotic arm control in space are presented. Most fundamentally, these four work situations are united by thee factors: the inability of the primary control operator to directly see the worksite, the need for high-precision coordination with colleagues, and the loss of situational awareness created by working in such environments. While RAS is relatively new, refueling teams, construction crews, and astronauts have been working under such conditions for much longer. As a result, this paper offers a series of best practice suggestions derived from other fields’ experiences similar working conditions.

To decrease medication errors, a common cause of injury to patients, we developed a novel electronic tool to facilitate asynchronous communication between healthcare professionals (HCPs) and patients for medication reconciliation. However, it was unknown whether the tool adequately supported HCPs’ usability needs. Our objective was to conduct an iterative usability evaluation of the tool with physicians, nurses, and pharmacists, in preparation for a randomized controlled trial. We hypothesized that we would identify design weaknesses that could be addressed via interface modifications prior to the trial. We completed a mixed-method, formative usability evaluation with 20 HCPs in the Veterans Affairs (VA) Health Services Research and Development, Human-Computer Interaction and Simulation Laboratory located within a major medical center. The tool in this study is formally known as the Secure Messaging for Medication Reconciliation Tool (SMMRT). The evaluation consisted of four sequential steps: 1) phase I usability testing to assess the baseline tool along with small, iterative design changes throughout testing; 2) heuristic evaluation; 3) implement major design changes that incorporate findings from previous steps; and 4) phase II usability testing to assess the implemented design changes and further refine the tool. This presentation focuses on steps 1 and 4 related to usability testing. During testing, HCPs worked through a real case consisting of a patient discharged from the hospital within the past 30 days who had at least 5 outpatient medications. We collected data on efficiency, usability errors, and participants’ satisfaction, along with participants’ ability to detect and address three distinct types of medication errors via the tool. For the latter, we inserted three safety probes into the simulation: 1) a missing medication (i.e., omission); 2) an extraneous medication (i.e., commission); and 3) an inaccurate dose (i.e., dose discrepancy). Data were analyzed descriptively, rather than via statistical comparisons, due to the formative and iterative nature of this research. There was no indication of efficiency gains during iterative prototyping and testing. Highlights of usability errors included confusion about medication entry fields; incorrect assumptions regarding medication list accuracy; inadequate medication information sorting and organization; and premature closure. Additionally, HCPs described usability errors that might occur in clinical practice. For example, medication images on the tool may not match what is dispensed to patients. HCPs also expressed concern that medication updates made via the tool may not be consistently updated in the electronic health record. In terms of satisfaction, HCPs’ ratings tended to increase as design modifications were implemented. After phase II usability testing, their overall satisfaction was favorable. Finally, for each of the three safety probes, 50% or fewer of HCPs identified the associated medication error. This research illustrates the importance of usability evaluations as a precursor to randomized trials of health information technology. Our multi-step approach to usability testing, with heuristic evaluation at the midpoint, may inform the design of other usability evaluations. While efficiency gains were not realized, user satisfaction improved. The inclusion of safety probes was especially valuable, since probes allowed us to assess error detection rates. There may be opportunities for human factors professionals to expand the sophistication and types of probes used in future healthcare research. Future studies are needed to develop more advanced design approaches that facilitate healthcare professionals’ detection of medication errors.