Domain

Evidence (e.g. research results from CER, PCOR, or QI)

Type

Empirical Study

Theme

effectiveness

Start Date

7-6-2014 1:15 PM

End Date

7-6-2014 2:45 PM

Structured Abstract

1) Introduction

With the rise of the electronic health record (EHR) to improve the efficiency and quality of health care, there is an abundance of electronic tools being integrated at the point of care. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool is currently being implemented into health systems nationally via paper and electronic mediums. It is important to analyze SBIRT integration to guide national dissemination. The hypothesis for this study is an electronic SBIRT tool will seamlessly integrate into workflow versus the traditional paper version. The constructs evaluated for integration were system, clinical, and personal workflow.

2) Methods

Cognitive distribution workflows were mapped with and without the use of the SBIRT tool to assess the impact on the system and clinical workflow. Medical Office Assistants (MOAs) who received trainings on both the paper and electronic versions were audio and video recorded using both versions of the SBIRT tool during a standardized patient visit. Following the visit, the MOAs participated in informant interviews regarding their experiences with the SBIRT screening tool. Recordings and answers were analyzed by two raters for thematic similarities.

3) Findings

Delivery of SBIRT paper version was on average 48.5 seconds faster. Discrepancies in the EHR version’s design and poor user interface were factors for delays. Furthermore, clinical workflow barriers of the electronic version include less patient interaction, potential to miss screens, and failure to submit screens into the EHR. Personal workflow barriers cited were the EHR tool was more cumbersome and disruptive to patient visits.

4) Discussion

The importance of proper testing of all mediums of screening tools is highlighted by the results of this study. On the system level it is important to address critical workflow issues of the EHR, while understanding the capacity and functionality of the EHR system. Patient care is a key concept to consider in terms of clinical workflow. The electronic version created an environment with less patient interaction and therefore was less personable when incorporated into the clinical workflow. Also improper use of the electronic tool resulted in the screen not being documented in the patients’ chart which can result in missed follow-ups. Finally, it is necessary to consider the impact a service tool has on the user, in this case the MOAs. The electronic tool was reported as far less user friendly, being difficult to navigate and time consuming. Inconsistencies in the tool led to disruption of adoption across mediums.

5) Conclusion

It is necessary to understand the pros and cons of the system, clinical, and personal workflows of each generation of EHR screening tools. More importantly, EHR tools’ usability should be compared to other mediums, before deeming it an augmentation in workflow. With the advances of health IT, progression of meaningful use, national dissemination of SBIRT, and implementation of EHR health systems, health systems are eager to implement IT solutions. This study demonstrates that IT tools, if implemented without usability testing, can result in poor workflow and could impede adoption rates compared to traditional means.

Acknowledgements

N/A

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Share

COinS
 
Jun 7th, 1:15 PM Jun 7th, 2:45 PM

Benefits of usability testing for the integration of a National substance use screening tool into the Electronic Health Record

1) Introduction

With the rise of the electronic health record (EHR) to improve the efficiency and quality of health care, there is an abundance of electronic tools being integrated at the point of care. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool is currently being implemented into health systems nationally via paper and electronic mediums. It is important to analyze SBIRT integration to guide national dissemination. The hypothesis for this study is an electronic SBIRT tool will seamlessly integrate into workflow versus the traditional paper version. The constructs evaluated for integration were system, clinical, and personal workflow.

2) Methods

Cognitive distribution workflows were mapped with and without the use of the SBIRT tool to assess the impact on the system and clinical workflow. Medical Office Assistants (MOAs) who received trainings on both the paper and electronic versions were audio and video recorded using both versions of the SBIRT tool during a standardized patient visit. Following the visit, the MOAs participated in informant interviews regarding their experiences with the SBIRT screening tool. Recordings and answers were analyzed by two raters for thematic similarities.

3) Findings

Delivery of SBIRT paper version was on average 48.5 seconds faster. Discrepancies in the EHR version’s design and poor user interface were factors for delays. Furthermore, clinical workflow barriers of the electronic version include less patient interaction, potential to miss screens, and failure to submit screens into the EHR. Personal workflow barriers cited were the EHR tool was more cumbersome and disruptive to patient visits.

4) Discussion

The importance of proper testing of all mediums of screening tools is highlighted by the results of this study. On the system level it is important to address critical workflow issues of the EHR, while understanding the capacity and functionality of the EHR system. Patient care is a key concept to consider in terms of clinical workflow. The electronic version created an environment with less patient interaction and therefore was less personable when incorporated into the clinical workflow. Also improper use of the electronic tool resulted in the screen not being documented in the patients’ chart which can result in missed follow-ups. Finally, it is necessary to consider the impact a service tool has on the user, in this case the MOAs. The electronic tool was reported as far less user friendly, being difficult to navigate and time consuming. Inconsistencies in the tool led to disruption of adoption across mediums.

5) Conclusion

It is necessary to understand the pros and cons of the system, clinical, and personal workflows of each generation of EHR screening tools. More importantly, EHR tools’ usability should be compared to other mediums, before deeming it an augmentation in workflow. With the advances of health IT, progression of meaningful use, national dissemination of SBIRT, and implementation of EHR health systems, health systems are eager to implement IT solutions. This study demonstrates that IT tools, if implemented without usability testing, can result in poor workflow and could impede adoption rates compared to traditional means.