Component 15 Unit 6: Electronic Health Records and Usability

Component 15 Unit 6: Electronic Health Records and Usability Self-Assessment 1. Which of the following best characterizes the importance of usability in the implementation of electronic health records? A. It contributes to the science of the field B. It helps clinicians do their work better C. It means users will have a positive attitude to implementation of electronic health records D. It can help prevent medical errors E. All of the above

2. What are some of the challenges in making EHR software usable? A. Lack of information and standards on what makes EHRs usable B. Contracts that may prohibit customers from talking about their experience C. Workplaces with complex tasks and interruptions D. Poor knowledge about back-end databases E. A, B, and C only

3. All of the following are reasons why implementation of EHRs in the healthcare setting is a challenge EXCEPT for which one? A. Learned helplessness of clinicians B. Political and power struggle of administration C. Lack of clinician input at design D. The socially distributed nature of the facility

4. Which of the following statements best reflects the ‘hold harmless’ legal clause? A. Vendors take full responsibility for errors regardless of the time frame since implementation B. Vendors take responsibility only when the error is made during the first six months of implementation C. Vendors and institutions share the responsibility for errors regardless of the time frame since implementation D. Vendors take no responsibility for errors regardless of the time frame of implementation.

5. Which of the following is a factor that affects the usability of an EHR system in a healthcare facility? A. Screen display B. Software design

Component15/Unit6 Health IT Workforce Curriculum 1 Version 2.0/Spring 2011

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. C. Workflow D. A and B E. All of the above

6. Which of the following is a Computerized Physician Order Entry (CPOE) usability problem documented by Dr. Koppel in 2005? A. Inability to clearly identify patients B. Inability to view medications at once C. Inability to login and logout D. A and B E. All of the above

7. All of the following are aspects of usability according to Health Information Management System Society (HIMSS) EXCEPT for which one? A. Naturalness B. Consistency C. Dependability D. Feedback E. Forgiveness

8. Which of the following principles of usability refers to making a system intuitive to users? A. Naturalness B. Consistency C. Simplicity D. Cognitive resources E. Efficient interactions

9. Which of the following principles of usability refer to making a user choose items from a list rather than typing in commands? A. Cognitive resources B. Efficient interactions C. Feedback D. Effective information E. Simplicity

10. Which of the following principles of usability refer to allowing the user to take shortcuts for a specific task, such as auto-tabbing? A. Cognitive resources B. Efficient interactions C. Feedback D. Effective information E. Simplicity

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. 11. All of the following are cognitive resources EXCEPT for which one? A. Perception B. Attention C. Memory D. Color vision

12. In the context of usability, which of the following is a reason why forgiveness and feedback are important? A. They facilitate users exploring the system B. They can prevent errors C. They can facilitate learning D. B and C E. All of the above

13. According to conventions common in the United States, which color indicates safety? A. Yellow B. Red C. Green D. Blue E. Black

14. Which of the following is not a practice of good interface usability? A. Making the user search through the system B. Juxtaposing related information C. Filtering lists D. Minimizing cognitive load E. All of the above

15. All of the following are examples of poor interface design that could cause an error EXCEPT for which one? A. Coloring text red to indicate normal results B. Sorting data and lab reports alphabetically C. Distributing data over several screens D. Making the user click on a picture

16. Which of the following is an aspect of modern ‘web 2.0’ approaches to EHRs? A. They allow for better interaction experiences B. Forbidding users to have control of the system C. They are concerned with technical specifications D. They deal with the individual user experience exclusively E. They cannot adapt to change

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. 17. Define the term ‘crowd sourcing’ and give an example of this term in relation to EHR usability. ______

18. Identify the TWO (2) approaches of usability testing and provide a description and ONE (1) example of each: Approaches of Usability Testing: 1. ______2. ______Description of Approach: 1. ______2. ______Example of Approach: 1. ______2. ______

19. Which of the following is an important consideration when conducting a focus group? A. To make subjects feel relaxed and free to speak B. To make sure they know a lot about the topic C. To ask specific factual questions with yes/no answers D. To include supervisors if possible E. To make sure people are aware of who participated

20. Which of the following is an advantage of think aloud testing? A. It gives us a realistic picture of what clinicians are thinking as they use the system B. It provides recordings, which can be analyzed in detail C. It shows us the problems that will occur when a system is deployed in real life D. A and B E. All of the above

21. Which of the following is an advantage of field usability testing? A. Introduce additional factors not present in the laboratory B. Informs researchers of workflow of staff processes C. Informs researchers of the type of time constraints D. A and C E. All of the above

22. Write a one (1) to (2) page response to the scenario given below.

Case Study A patient presented to his primary care physician (PCP) for the treatment of headaches and episodes of altered consciousness. The PCP prescribed amitripyline at 10 mg

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. nightly. The PCP told the patient to escalate the dosage by 10 mg every three to four days until the pain was relieved, but not to exceed 50 mgs without consulting him.

When creating the prescription, the PCP intended to check off the 10-mg box in the computerized physician order entry (CPOE), but inadvertently checked the 100-mg box, which was right above it. In the medication instructions section, he indicated that five pills could be taken per night, so the patient would not have to return to the pharmacy and pay additional co-pay if he ultimately needed the larger dose.

The pharmacist had noticed that the dose seemed high and requested that a call be made to the PCP prior to it being dispensed. A nurse at the PCP’s office picked up the call, and because she was very busy that day, told the pharmacy to dispense the medication as it had been ordered — she did not check the dose. Three days later, the patient took five of the 100-mg pills together. Early the next morning, the PCP was contacted by an emergency department (ED) physician who reported that the patient was in the ED reporting dizziness, an altered state of consciousness, an inability to coordinate his movements and a rapid heartbeat.

He was further informed by the ED physician that the patient had taken five 100-mg amitripyline tablets. The PCP then checked the patient’s record and realized his mistake.

How could the design of the system be changed to prevent such errors in future?

1. Using the ten principles of usability, make at least SIX (6) recommendations to correct this problem in the future.

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.