Usability Testing and the Relation of Clinical Information Systems to Patient Safety

Background: The success of clinical information systems depends upon their effective integration into complex work systems involving distributed responsibility and decisionmaking. Human-computer interaction (HCI) deficiencies and mismatches between systems design and the structure of work create the potential for new paths to system failures (e.g., allergy lists not directly visible on a screen). The use of human factors methods is widespread in other industries and can predict some of these new failure paths, facilitating redesign to prevent accidents-in-the-making. This paper will discuss the application of scenario-based usability testing in clinical health care settings. Methods: Using scenario-based usability testing methods, we investigated point-of-care software technology (e.g., barcoded medication administration [BCMA] and wireless medication administration [WMA]) in an attempt to better understand the safety implications of HCI design decisions. The use of scenarios in usability testing focuses attention on specific aspects of the interface to identify pitfalls and system failures. The scenarios were developed after extensive ethnographic observation of the medical work with bar-coding software and the computerized order entry system (COES). Results: The paper lays out the methodology of scenario-based usability testing for use in health care. We were able to identify new paths to failures using this method and recommended the software to simplify and support the user’s tasks. Scenario-based testing also identified workplace performance trade-offs related to time and production pressures. Conclusion: Scenario-based usability testing is an important methodology that characterizes how humansoftware interaction contributes to success or failure in clinical system implementations. Usability testing can identify and promote data-driven design choices culled from practitioner use of the system in a busy work environment. Human factors knowledge of HCI design and its impact on human performance can advance safety in health care.