Interface design recommendations for computerised clinical audit and feedback: Hybrid usability evidence from a research-led system



Brown, Benjamin, Balatsoukas, Panos, Williams, Richard, Sperrin, Matthew and Buchan, Iain ORCID: 0000-0003-3392-1650
(2016) Interface design recommendations for computerised clinical audit and feedback: Hybrid usability evidence from a research-led system. INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS, 94. pp. 191-206.

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Abstract

<h4>Background</h4>Audit and Feedback (A&F) is a widely used quality improvement technique that measures clinicians' clinical performance and reports it back to them. Computerised A&F (e-A&F) system interfaces may consist of four key components: (1) Summaries of clinical performance; (2) Patient lists; (3) Patient-level data; (4) Recommended actions. There is a lack of evidence regarding how to best design e-A&F interfaces; establishing such evidence is key to maximising usability, and in turn improving patient safety.<h4>Aim</h4>To evaluate the usability of a novel theoretically-informed and research-led e-A&F system for primary care (the Performance Improvement plaN GeneratoR: PINGR).<h4>Objectives</h4>(1) Describe PINGR's design, rationale and theoretical basis; (2) Identify usability issues with PINGR; (3) Understand how these issues may interfere with the cognitive goals of end-users; (4) Translate the issues into recommendations for the user-centred design of e-A&F systems.<h4>Methods</h4>Eight experienced health system evaluators performed a usability inspection using an innovative hybrid approach consisting of five stages: (1) Development of representative user tasks, Goals, and Actions; (2) Combining Heuristic Evaluation and Cognitive Walkthrough methods into a single protocol to identify usability issues; (3) Consolidation of issues; (4) Severity rating of consolidated issues; (5) Analysis of issues according to usability heuristics, interface components, and Goal-Action structure.<h4>Results</h4>A final list of 47 issues were categorised into 8 heuristic themes. The most error-prone heuristics were 'Consistency and standards' (13 usability issues; 28% of the total) and 'Match between system and real world' (n=10, 21%). The recommended actions component of the PINGR interface had the most usability issues (n=21, 45%), followed by patient-level data (n=5, 11%), patient lists (n=4, 9%), and summaries of clinical performance (n=4, 9%). The most error-prone Actions across all user Goals were: (1) Patient selection from a list; (2) Data identification from a figure (both population-level and patient-level); (3) Disagreement with a system recommendation.<h4>Conclusions</h4>By contextualising our findings within the wider literature on health information system usability, we provide recommendations for the design of e-A&F system interfaces relating to their four key components, in addition to how they may be integrated within a system.

Item Type: Article
Uncontrolled Keywords: Clinical audit, Medical audit, Clinical quality management, Clinical quality improvement, Clinical governance, User interface design, Hybrid usability inspection, Usability studies, Clinical decision support systems
Depositing User: Symplectic Admin
Date Deposited: 27 Mar 2019 10:07
Last Modified: 19 Jan 2023 00:56
DOI: 10.1016/j.ijmedinf.2016.07.010
Open Access URL: https://doi.org/10.1016/j.ijmedinf.2016.07.010
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3035077