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Comp 15 - Usability & Human Factors

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  1. Comp 15 - Usability & Human Factors Unit 10a - Designing for Safety This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.

  2. Designing for Safety Health IT Workforce Curriculum Version 2.0/Fall 2011

  3. Patient Safety Health IT Workforce Curriculum Version 2.0/Fall 2011

  4. Errors Health IT Workforce Curriculum Version 2.0/Fall 2011

  5. Pediatrics: Increased Mortality with Computerized Physicians Order Entry (CPOE) Health IT Workforce Curriculum Version 2.0/Fall 2011

  6. Increased Mortality: Reasons (from Sittig, 2008) Health IT Workforce Curriculum Version 2.0/Fall 2011

  7. Increased Mortality: Reasons (cont.) Health IT Workforce Curriculum Version 2.0/Fall 2011

  8. Horsky: Dosing Error (Detailed Analysis) Health IT Workforce Curriculum Version 2.0/Fall 2011

  9. Errors, Safety, Perfectibility:Errors Viewed in 2 Ways Health IT Workforce Curriculum Version 2.0/Fall 2011

  10. Human Factors (Elrod, 2009) Health IT Workforce Curriculum Version 2.0/Fall 2011

  11. Design Considerations(from Kaye, 2010) Health IT Workforce Curriculum Version 2.0/Fall 2011

  12. “Use Safety” Evaluation (Kaye 2010) Health IT Workforce Curriculum Version 2.0/Fall 2011

  13. Retrospective Incident Analysis Health IT Workforce Curriculum Version 2.0/Fall 2011

  14. Order Sets Health IT Workforce Curriculum Version 2.0/Fall 2011

  15. Controversies Surrounding Order Sets A number of design features would increase the utility and safety of the care prescribed through order sets. Individual orders within order sets should be linked, if so desired by the client. For example, drug A is to begin at time zero, and linked orders for drug B and drug C begin 4 and 8 hours after drug A. When drug A is delayed by 2 hours, drug B and C are automatically moved back by 2 hours. This decreases the risk for error and amount of downstream re-work and is particularly useful for fully integrated EHRs with online electronic medication administration records. Health IT Workforce Curriculum Version 2.0/Fall 2011

  16. Patient Controlled Analgesia Health IT Workforce Curriculum Version 2.0/Fall 2011

  17. Examples of CPOE Design Features Health IT Workforce Curriculum Version 2.0/Fall 2011

  18. No Default Selections Health IT Workforce Curriculum Version 2.0/Fall 2011

  19. Other Design Requirements Health IT Workforce Curriculum Version 2.0/Fall 2011

  20. Order Set Safety Health IT Workforce Curriculum Version 2.0/Fall 2011

  21. Review and Supervision Health IT Workforce Curriculum Version 2.0/Fall 2011

  22. Unintended Consequences of CPOE (Campbell et al. 2006) • more/new work for clinician; • unfavorable workflow issues • never ending system demands • problems related to paper persistence • untoward changes in communication patterns and practices • negative emotions • generation of new kinds of errors • unexpected changes in the power structure • overdependence on the technology. Clinical decision support features introduced many of these unintended consequences Identifying Unintended Adverse Consequences (UAC) can allow design to avoid negative consequences Health IT Workforce Curriculum Version 2.0/Fall 2011

  23. Checklists – Gawande Health IT Workforce Curriculum Version 2.0/Fall 2011

  24. Checklists – Gawande (cont.) Health IT Workforce Curriculum Version 2.0/Fall 2011

  25. Pronovost Health IT Workforce Curriculum Version 2.0/Fall 2011

  26. Pronovost (cont.) Health IT Workforce Curriculum Version 2.0/Fall 2011

  27. Pronovost – UIC Health IT Workforce Curriculum Version 2.0/Fall 2011

  28. Shabot - Ten Commandments for CIS 1. Speed is everything. 2. Realize that doctors won't wait for the computer's pearls. 3. Deliver “just-in-time” information. 4. Fit into the user's workflow. 5. Respect physicians' sense of autonomy. 6. Monitor implementation in real time and respond “right now.” 7. Beware of unintended consequences. 8. Be wary of uncovering long-standing process flaws. 9. Don't disrupt “magic nursing glue.” 10. Speed is everything. Health IT Workforce Curriculum Version 2.0/Fall 2011

  29. Additional Reference: Top 10 Sentinel Events (reviewed by JCAHO 2008) by type Health IT Workforce Curriculum Version 2.0/Fall 2011