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First published June 28, 2007 as JAMIA PrePrint; doi:10.1197/jamia.M2163
Journal of the American Medical Informatics Association 2007;14(5):632-640
© 2007 American Medical Informatics Association

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Submitted on May 25, 2006
Accepted on June 11, 2007

Impact of Clinical Reminder Redesign on Learnability, Efficiency, Usability, and Workload for Ambulatory Clinic Nurses

Jason J. Saleem PhD1*, Emily S. Patterson PhD2, Laura Militello MA3, Shilo Anders MA4, Mercedes Falciglia MD5, Jennifer A. Wissman MS6, Emilie M. Roth PhD7, and Steven M. Asch MD, MPH8

Affiliation of the authors: 1 Research Scientist, VA Getting at Patient Safety (GAPS) Center, VAMC - Cincinnati, Cincinnati, OH; VA HSR&D Center on Implementing Evidence-based Practice, Roudebush VAMC - Indianapolis, Indianapolis, IN ; 2 VA Getting at Patient Safety (GAPS) Center, VAMC - Cincinnati, Cincinnati, OH; Institute for Ergonomics, The Ohio State University, Columbus, OH ; 3 University of Dayton Research Institute, Dayton OH ; 4 Cognitive Systems Engineering Laboratory, The Ohio State University, Columbus, OH ; 5 VA Getting at Patient Safety (GAPS) Center, VAMC - Cincinnati; Department of Internal Medicine, University of Cincinnati, Cincinnati, OH ; 6 VA Getting at Patient Safety (GAPS) Center, VAMC - Cincinnati, Cincinnati, OH ; 7 Roth Cognitive Engineering, Brookline, MA; 8 VA Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA

* To whom correspondence should be addressed.

Objective Computerized clinical reminders (CRs) were designed to reduce clinicians' reliance on their memory and to present evidence-based guidelines at point of care. However, the literature indicates that CR adoption and effectiveness has been variable. We examined the impact of four design modifications to CR software on learnability, efficiency, usability, and workload for intake nursing personnel in an outpatient clinic setting. These modifications were included in a redesign primarily to address barriers to effective CR use identified during a previous field study.

Design In a simulation experiment, 16 nurses used prototypes of the current and redesigned system in a within-subject comparison for five simulated patient encounters. Prior to the experimental session, participants completed an exploration session, where "learnability" of the current and redesigned systems was assessed.

Measurements Time, performance, and survey data were analyzed in conjunction with semi-structured debrief interview data.

Results The redesign was found to significantly increase learnability for first-time users as measured by time to complete the first CR, efficiency as measured by task completion time for two of five patient scenarios, usability as determined by all three groupings of questions taken from a commonly used survey instrument, and two of six workload subscales of the NASA Task Load Index (TLX) survey: mental workload and frustration.

Conclusion Modest design modifications to existing CR software positively impacted variables that likely would increase the willingness for first-time nursing personnel to adopt and consistently use CRs.




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