One group’s workflow that would be important to consider while designing and implementing a health information exchange would be physicians. Since many of the users of HIE systems that are being developed are clinicians, their workflow and processes would be very important when designing and implementing health information exchanges. With the introduction of new technology, architects need to understand how the technology changes workflow for the users. One example of this is a study that was conducted to understand how HIE implementation changed workflow for multiple practice sites and emergency departments. In this study, they examined both the nurse workflows and the provider workflows. According to the article, “Nurses’ exchange use was highly focused on recent hospital visits and they rarely browsed medical history” while “Nurse practitioners and physicians accessed the exchange for a wider range of reasons than nurses” (Unertl, Johnson, & Lorenzi, 2011). They found that because nurses preferred summaries over raw data, “nurse access to the exchange was often frustrated by summary data unavailability” (Unertl et al., 2011). This is different from physicians, where they “accessed a broader scope of information and browsed more of a patient’s medical history” (Unertl et al., 2011). Knowing the uses of the HIE, the engineers behind the systems would be able to adjust the user experience and offer features that would help users complete their tasks efficiently. In this example, offering summary services to nurses would improve the HIE.
When considering implementing solutions, looking at previous uses is important because it allows for recognition of the failures of these systems and where improvement needs to be made. In another study that evaluated the use of HIE in emergency departments, where researchers found that “the most frequent health information exchange use was for diagnostics, discharge summaries, histories, and physicals” but this usage varied as not all providers used it frequently (Thorn, Carter, & Bailey, 2014). In the article, it is noted that the “core barrier to higher usage is difficulty accessing health information exchange” (Thorn et al., 2014). The providers “ wanted consistent data so that they knew what information was available, reports would be easy to find, and needed information was available” (Thorn et al., 2014). In this case, designers of the HIE would have to evaluate the user’s responses to find ways to increase usability and improve workflow. For new implementations of HIE, architects need to be sure that they consider the use cases and workflows of the providers so that during implementation the users find the tools helpful. Additionally, during implementation there should be consistent improvement in the HIE to adjust the system to complement the workflow of the providers. This is in line with some of the AHRQ Health IT tools for workflow. When considering the AHRQ Health IT tools for workflow, one of the tools is to assess and adjust workflows. This can be done during the implementation phase and it allows for improvement to the system to ensure that usage rises by making sure the intervention is more beneficial than a burden.
Human factors is “the discipline that tries to optimize the relationship between technology and the human” (Meyer, 2010). To be more precise, human factors “ applies knowledge about human strengths and limitations to the design of interactive systems of people, equipment, and their environment to ensure their effectiveness, safety, and ease of use” (Henricksen et al). In order to optimize this relationship, usability of the technology is extremely important. This can be done through a user-centered design process, which is “a set of methods to address user needs throughout the product life cycle” (Meyer, 2010). Using human factors and user-centered design will improve the usability and usefulness of technology.
In one area that physicians and nurses get frustrated with health technology is burnout and “click fatigue.” The issues of “click fatigue” comes in when providers spend more time interacting with technology and screens than they do patients. As providers spend less time completing tasks on screens and use less clicks to get the information they need, the more time they have to tackle patient centered tasks. This is important because “70% of doctors using EHRs attribute the bulk of their administrative burden to the software” (Collier, 2018). When the software is optimized for the workflows of the practice, time is saved. This is a human factors issue because the designers of the software must consider the workflows of the users to increase usability and efficiency. Another important factor to note is that researchers have found that “the quality of documentation by medical residents decreased as the number of dialog boxes they had to open to record information increased” (Collier, 2018). Optimizing the software to fit with the workflow of the users without making it overly complicated is important to ensure efficiency and quality.
In terms of health information exchange, this is important because designers of the systems must be able to identify multiple use cases and then tailor the experience to those users. For example, the use of the health information exchange in the emergency department would differ from the use of a pharmacist trying to reconcile a patient’s medication. While the HIE system would be the same, the interface for each user would have to be different depending on their needs. This is where human factors comes in, where architects need to consider the human element, or how the user’s workflow functions, during the design and implementation process.
References
Beth, M. (2016, June 16). Introduction to Human Factors and Usability in Health IT Design. Retrieved October 28, 2020, from http://www.himss.org/News/NewsDetail.aspx?ItemNumber=6088
Collier, R. (2018). Rethinking EHR interfaces to reduce click fatigue and physician burnout. Canadian Medical Association Journal, 190(33). doi:10.1503/cmaj.109-5644
Henricksen et al. Chapter 5. Understanding Adverse Events: A Human Factors Framework
Thorn, S. A., Carter, M. A., & Bailey, J. E. (2014). Emergency Physicians’ Perspectives on Their Use of Health Information Exchange. Annals of Emergency Medicine, 63(3), 329-337. doi:10.1016/j.annemergmed.2013.09.024
Unertl, K. M., Johnson, K. B., & Lorenzi, N. M. (2011). Health information exchange technology on the front lines of healthcare: Workflow factors and patterns of use. Journal of the American Medical Informatics Association, 19(3), 392-400. doi:10.1136/amiajnl-2011-000432