An Interface-driven Analysis of User Interactions with an Electronic Health Records System

Overview

Journal J Am Med Inform Assoc

Publisher Oxford University Press

Specialty Medical Informatics

Date 2008 Dec 17

PMID 19074301

Citations 45

Authors

Kai Zheng

Rema Padman

Michael P Johnson

Herbert S Diamond

Affiliations

Soon will be listed here.

Abstract

Objectives: This study sought to investigate user interactions with an electronic health records (EHR) system by uncovering hidden navigational patterns in the EHR usage data automatically recorded as clinicians navigated through the system's software user interface (UI) to perform different clinical tasks.

Design: A homegrown EHR was adapted to allow real-time capture of comprehensive UI interaction events. These events, constituting time-stamped event sequences, were used to replay how the EHR was used in actual patient care settings. The study site is an ambulatory primary care clinic at an urban teaching hospital. Internal medicine residents were the primary EHR users.

Measurements: Computer-recorded event sequences reflecting the order in which different EHR features were sequentially accessed.

Methods: We apply sequential pattern analysis (SPA) and a first-order Markov chain model to uncover recurring UI navigational patterns.

Results: Of 17 main EHR features provided in the system, SPA identified 3 bundled features: "Assessment and Plan" and "Diagnosis," "Order" and "Medication," and "Order" and "Laboratory Test." Clinicians often accessed these paired features in a bundle together in a continuous sequence. The Markov chain analysis revealed a global navigational pathway, suggesting an overall sequential order of EHR feature accesses. "History of Present Illness" followed by "Social History" and then "Assessment and Plan" was identified as an example of such global navigational pathways commonly traversed by the EHR users.

Conclusion: Users showed consistent UI navigational patterns, some of which were not anticipated by system designers or the clinic management. Awareness of such unanticipated patterns may help identify undesirable user behavior as well as reengineering opportunities for improving the system's usability.

Citing Articles

The relationship between electronic health records user interface features and data quality of patient clinical information: an integrative review.

Madandola O, Bjarnadottir R, Yao Y, Ansell M, Dos Santos F, Cho H J Am Med Inform Assoc. 2023; 31(1):240-255.

PMID: 37740937 PMC: 10746323. DOI: 10.1093/jamia/ocad188.

Characterizing the macrostructure of electronic health record work using raw audit logs: an unsupervised action embeddings approach.

Lou S, Liu H, Harford D, Lu C, Kannampallil T J Am Med Inform Assoc. 2022; 30(3):539-544.

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Introduction of Systematized Nomenclature of Medicine-Clinical Terms Coding Into an Electronic Health Record and Evaluation of its Impact: Qualitative and Quantitative Study.

Pankhurst T, Evison F, Atia J, Gallier S, Coleman J, Ball S JMIR Med Inform. 2021; 9(11):e29532.

PMID: 34817387 PMC: 8663536. DOI: 10.2196/29532.

Systematic review of applied usability metrics within usability evaluation methods for hospital electronic healthcare record systems: Metrics and Evaluation Methods for eHealth Systems.

Wronikowska M, Malycha J, Morgan L, Westgate V, Petrinic T, Young J J Eval Clin Pract. 2021; 27(6):1403-1416.

PMID: 33982356 PMC: 9438452. DOI: 10.1111/jep.13582.

Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial.

Kato-Lin Y, Kumar U, Sri Prakash B, Prakash B, Varadan V, Agnihotri S JMIR Mhealth Uhealth. 2020; 8(11):e15717.

PMID: 33206054 PMC: 7710449. DOI: 10.2196/15717.

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