A Cognitive Model Approach to Creating Usable Health Care Content

Clinical Decision Support, 2014

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2003

As the healthcare industry transitions from paper to electronic medical records (EMRs), medical informatics researchers face the task of ensuring that the electronic presentation of the information remains usable and effective while capitalizing on the ability of EMRs to tailor information to different users. In our research, we focus on utilizing formal cognitive science methodology to guide the conversion of paper-based narrative discharge summaries to a more dynamic, structured electronic version. In this paper, we present the results of a cognitive analytic study (1) that determines a 'core' component in medical narratives and (2) that compares the use of structured and narrative texts by physicians with varying expertise. Specifically, we studied six psychiatrists at three levels of expertise- experts, intermediates, and novices. The subjects were given two clinical case scenarios with discharge summaries and asked to verbalize their thoughts as they read through the su...

Proceedings : a conference of the American Medical Informatics Association / ... AMIA Annual Fall Symposium. AMIA Fall Symposium, 1997

This paper describes an approach to the evaluation of health care information technologies based on usability engineering and a methodological framework from the study of medical cognition. The approach involves collection of a rich set of data including video recording of health care workers as they interact with systems, such as computerized patient records and decision support tools. The methodology can be applied in the laboratory setting, typically involving subjects "thinking aloud" as they interact with a system. A similar approach to data collection and analysis can also be extended to study of computer systems in the "live" environment of hospital clinics. Our approach is also influenced from work in the area of cognitive task analysis, which aims to characterize the decision making and reasoning of subjects of varied levels of expertise as they interact with information technology in carrying out representative tasks. The stages involved in conducting c...

Journal of Biomedical Informatics, 2004

Increasingly healthcare policy and decision makers are demanding evidence to justify investments in health information systems. This demand requires an adequate evaluation of these systems. A wide variety of approaches and methodologies have been applied in assessing the impact of information systems in health care, ranging from controlled clinical trials to use of questionnaires and interviews with users. In this paper we describe methodological approaches which we have applied and refined for the past 10 years for the evaluation of health information systems. The approaches are strongly rooted in theories and methods from cognitive science and the emerging field of usability engineering. The focus is on assessing human computer interaction and in particular, the usability of computer systems in both laboratory and naturalistic settings. The methods described can be a part of the formative evaluation of systems during their iterative development, and can also complement more traditional assessment methods used in summative system evaluation of completed systems. The paper provides a review of the general area of systems evaluation with the motivation and rationale for methodological approaches underlying usability engineering and cognitive task analysis as applied to health information systems. This is followed by a detailed description of the methods we have applied in a variety of settings in conducting usability testing and usability inspection of systems such as computer-based patient records. Emerging trends in the evaluation of complex information systems are discussed.

2004

Communication in healthcare makes up an important part of the healthcare professionals' daily practices. Communication encompasses different forms of interaction and dissemination of health-related information, and takes place in contexts such as patient/healthcare professional relationships, and collaborative care. While Information and Communication Technology (ICT) offers a useful means to support the accessibility, the exchange and the sharing of information, the cognitive complexity of these communication processes often remains undermined. Much can be learned from research in Human Computer Interaction (HCI) with its focus on cognitive aspects. This has relevant implications for our work in healthcare communication enabled by ICT.

International Journal of Medical Informatics, 2006

Objective: As healthcare practice transitions from paper-based to computer-based records, there is increasing need to determine an effective electronic format for clinical narratives. Our research focuses on utilizing a cognitive science methodology to guide the conversion of medical texts to a more structured, user-customized presentation in the electronic medical record (EMR). Design: We studied the use of discharge summaries by psychiatrists with varying expertise--experts, intermediates, and novices. Experts were given two hypothetical emergency care scenarios with narrative discharge summaries and asked to verbalize their clinical assessment. Based on the results, the narratives were presented in a more structured form. Intermediate and novice subjects received a narrative and a structured discharge summary, and were asked to verbalize their assessments of each. Measurements: A qualitative comparison of the interview transcripts of all subjects was done by analysis of recall and inference made with respect to level of expertise. Results: For intermediate and novice subjects, recall was greater with the structured form than with the narrative. Novices were also able to make more inferences (not always accurate) from the structured form than with the narrative. Errors occurred in assessments using the narrative form but not the structured form. Conclusions: Our cognitive methods to study discharge summary use enabled us to extract a conceptual representation of clinical narratives from end-users. This method allowed us to identify clinically relevant information that can be used to structure medical text for the EMR and potentially improve recall and reduce errors.

EHealth Beyond the …, 2008

Communications of the Association for Information Systems

While information and communication technologies can increase the health care provided to underserved populations, research concerning these technologies often involves only those patients who possess access to technology or who are otherwise willing and able to use it. This issue is important for both researchers and practitioners because non-users' beliefs may not only be different from users' beliefs, they may become more important to understand as access to technology increases. To address this problem: 1. We develop a model of the antecedents to perceived usefulness of an interactive health communication (IHC) system. While our research model combines health-related beliefs with technology perceptions, the antecedents can all be measured before an individual has contact with a particular IHC system. Thus, in the current (and in future) work, they can be used to assess the beliefs of individuals who may not currently be willing or able to use technology. 2. We test this model using paper-based scenarios that depict hypothetical interactions with an IHC system. These paper-based scenarios are more flexible and easier to use than a working system, thus we are able to obtain data from many sources, resulting in a perceptually diverse sample. Results of our hypothesis testing show that patients with higher knowledge and discipline are less likely than those with less knowledge and/or discipline to find an IHC system useful. In addition we learned several lessons from our research process including how to increase participation rates and what reactions to expect from participants.

Proceedings : a conference of the American Medical Informatics Association / ... AMIA Annual Fall Symposium. AMIA Fall Symposium, 1996

This paper describes an innovative approach to the evaluation of the user interface and vocabulary of a medical information system. The use of video recording for collecting usability data is detailed. The technique employed involves the collection of data consisting of transcripts of physicians as they "think aloud" while interacting with the system, along with a video record of the complete user-computer interaction. Using methods of analysis from cognitive science, the study was able to distinguish the source of physician problems in using the system's interface and in interacting with its controlled medical vocabulary. Analysis of the protocols indicated that all subjects encountered several generic problems, the most common ones indicative of a need for greater consistency in the interface design. Based on this evaluation, parts of the user interface have been re-implemented in an ongoing process of iterative system development.

Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, 2019

This project's purpose was to develop cognitively-focused usability evaluation methods for electronic health records (EHRs). This research involved developing a conceptual framework for evaluating EHR usability in terms of clinical cognition and operationalizing the framework in the form of two novel EHR usability evaluation methods. The two evaluation methods -one observational and one lab-based -are described in a suite of protocol materials and recommendations for EHR evaluation and design. This resulting body of work is referred to as CUE-E: Cognitive Usability Evaluation -EHR. This paper describes the process behind the development of the CUE-E evaluation methods, summarizes the use of both, and discusses directions for future work. The two CUE-E evaluation methods are currently ready for pilot applications to assess their reliability and validity and identify opportunities for further improvement.