This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cimino, J. J. Articles by Kushniruk, A. W. Search for Related Content PubMed PubMed Citation Articles by Cimino, J. J. Articles by Kushniruk, A. W.

Studying the Human– Computer–Terminology Interface

Affiliation of the authors: Columbia-Presbyterian Medical Center, New York, New York.

Correspondence and reprint requests: James J. Cimino, MD, Department of Medical Informatics, Columbia-Presbyterian Medical Center, 622 West 168th Street, VC-5, New York, NY 10032; e-mail: <jjc7{at}columbia.edu>.

Objective: To explore the use of an observational, cognitive-based approach for differentiating between successful, suboptimal, and failed entry of coded data by clinicians in actual practice, and to detect whether causes for unsuccessful attempts to capture true intended meaning were due to terminology content, terminology representation, or user interface problems.

Design: Observational study with videotaping and subsequent coding of data entry events in an outpatient clinic at New York Presbyterian Hospital.

Participants: Eight attending physicians, 18 resident physicians, and 1 nurse practitioner, using the Medical Entities Dictionary (MED) to record patient problems, medications, and adverse reactions in an outpatient medical record system.

Measurements: Classification of data entry events as successful, suboptimal, or failed, and estimation of cause; recording of system response time and total event time.

Results: Two hundred thirty-eight data entry events were analyzed; 71.0 percent were successful, 6.3 percent suboptimal, and 22.7 percent failed; unsuccessful entries were due to problems with content in 13.0 percent of events, representation problems in 10.1 percent of events, and usability problems in 5.9 percent of events. Response time averaged 0.74 sec, and total event time averaged 40.4 sec. Of an additional 209 tasks related to drug dose and frequency terms, 94 percent were successful, 0.5 percent were suboptimal, and 6 percent failed, for an overall success rate of 82 percent.

Conclusions: Data entry by clinicians using the outpatient system and the MED was generally successful and efficient. The cognitive-based observational approach permitted detection of false-positive (suboptimal) and false-negative (failed due to user interface) data entry.

This article has been cited by other articles:

				J. L. Schnipper, J. A. Linder, M. B. Palchuk, J. S. Einbinder, Q. Li, A. Postilnik, and B. Middleton "Smart Forms" in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 513 - 523. [Abstract] [Full Text] [PDF]

				S. T. Rosenbloom, R. A. Miller, K. B. Johnson, P. L. Elkin, and S. H. Brown A Model for Evaluating Interface Terminologies J. Am. Med. Inform. Assoc., January 1, 2008; 15(1): 65 - 76. [Abstract] [Full Text] [PDF]

				I. Cho and H.-A. Park Evaluation of the Expressiveness of an ICNP-based Nursing Data Dictionary in a Computerized Nursing Record System J. Am. Med. Inform. Assoc., July 1, 2006; 13(4): 456 - 464. [Abstract] [Full Text] [PDF]

				S. T. Rosenbloom, R. A. Miller, K. B. Johnson, P. L. Elkin, and S. H. Brown Interface Terminologies: Facilitating Direct Entry of Clinical Data into Electronic Health Record Systems J. Am. Med. Inform. Assoc., May 1, 2006; 13(3): 277 - 288. [Abstract] [Full Text] [PDF]

				V. Maojo and C. A. Kulikowski Bioinformatics and Medical Informatics: Collaborations on the Road to Genomic Medicine? J. Am. Med. Inform. Assoc., November 1, 2003; 10(6): 515 - 522. [Abstract] [Full Text] [PDF]

				P. J B Brown, V. Warmington, M. Laurence, and A T. Prevost Randomised crossover trial comparing the performance of Clinical Terms Version 3 and Read Codes 5 byte set coding schemes in general practice BMJ, May 22, 2003; 326(7399): 1127. [Abstract] [Full Text] [PDF]

				P. L. Elkin, B. Sorensen, D. De Palo, G. Poland, K. R. Bailey, D. L. Wood, and N. F. LaRusso Optimization of a Research Web Environment for Academic Internal Medicine Faculty J. Am. Med. Inform. Assoc., September 1, 2002; 9(5): 472 - 478. [Abstract] [Full Text] [PDF]

				Q. Zeng, J. J. Cimino, and K. H. Zou Providing Concept-oriented Views for Clinical Data Using a Knowledge-based System: An Evaluation J. Am. Med. Inform. Assoc., May 1, 2002; 9(3): 294 - 305. [Abstract] [Full Text] [PDF]