JMIR human factors
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Thousands of mobile health (mHealth) apps have been developed to support patients' management of their health, but the effectiveness of many of the apps remains unclear. While mHealth apps appear to hold promise for improving the self-management of chronic conditions across populations, failure to balance the system demands of the app with the needs, interests, or resources of the end users can undermine consumers' adoption of these technologies. ⋯ This brief trial underscores the pitfalls in the utilization of mHealth apps. Effective use of mHealth tools requires a good fit between the app, the users' electronic health (eHealth) literacy, the treatment approach, staff time, and reimbursement for services. The last 3 are contextual factors of the setting that affected the adoption of the app and context is an important factor in implementation science. We recommend that researchers address contextual factors in the trial and adoption of mHealth technologies.
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Chronic pain is more prevalent among women; however, the majority of standardized pain drawings are often collected using male-like androgynous body representations. ⋯ Providing gender-specific body charts may facilitate the communication of pain and the level of detail (2D vs 3D body charts) should be used according to patients' needs.
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Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on non-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical alarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important initial step toward this requirement is identifying ICU nurses' perceptions and common clinical practices toward clinical alarms, where little information is available. ⋯ False and non-actionable alarms continue to desensitize TCICU nurses, perhaps resulting in missing fatal alarms. Nurses' attitudes and practices related to clinical alarms are key elements for designing contextually sensitive quality initiatives to fight alarm fatigue. Alarm management in ICUs is a multidimensional complex process involving usability of monitoring devices, and unit, clinicians, training, and policy-related factors. This indicates the need for a multi-method approach to decrease alarm fatigue and improve alarm systems safety.
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As the electronic health record (EHR) becomes the preferred documentation tool across medical practices, health care organizations are pushing for clinical decision support systems (CDSS) to help bring clinical decision support (CDS) tools to the forefront of patient-physician interactions. A CDSS is integrated into the EHR and allows physicians to easily utilize CDS tools. However, often CDSS are integrated into the EHR without an initial phase of usability testing, resulting in poor adoption rates. Usability testing is important because it evaluates a CDSS by testing it on actual users. This paper outlines the usability phase of a study, which will test the impact of integration of the Wells CDSS for pulmonary embolism (PE) diagnosis into a large urban emergency department, where workflow is often chaotic and high stakes decisions are frequently made. We hypothesize that conducting usability testing prior to integration of the Wells score into an emergency room EHR will result in increased adoption rates by physicians. ⋯ This study successfully combined "think-aloud" protocol analysis with "near-live" clinical simulations in a usability evaluation of a CDS tool that will be implemented into the emergency room environment. Both methods proved useful in the assessment of the CDS tool and allowed us to refine tool usability and workflow.
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There is an increased demand in hospitals for tools, such as dedicated mobile device apps, that enable the recording of clinical information in an electronic format at the patient's bedside. Although the human-machine interface design on mobile devices strongly influences the accuracy and effectiveness of data recording, there is still a lack of evidence as to which interface design offers the best guarantee for ease of use and quality of recording. Therefore, interfaces need to be assessed both for usability and reliability because recording errors can seriously impact the overall level of quality of the data and affect the care provided. ⋯ Our study highlights the critical impact the choice of an interface can have on the quality of recorded data. Selecting an interface should be driven less by the needs of specific end-user groups or the necessity to facilitate the developer's task (eg, by opting for default solutions provided by commercial platforms) than by the level of speed and accuracy an interface can provide for recording information. An important effort must be made to properly validate mobile device interfaces intended for use in the clinical setting. In this regard, our study identified the numeric keyboard, among the proposed designs, as the most accurate interface for entering specific numerical values. This is an important step toward providing clearer guidelines on which interface to choose for the appropriate use of handheld device interfaces in the health care setting.