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2023 HSR&D/QUERI National Conference Abstract

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1013 — Clinicians’ user experience with VA’s health information exchange technologies: Think-aloud during simulated medication reconciliation

Lead/Presenter: Himalaya Patel,  COIN - Indianapolis
All Authors: Patel H (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center), Savoy A (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center; Indiana University-Purdue University Indianapolis; Regenstrief Institute, Inc.) Sanchez SL (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center) Traylor M (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center) Nguyen KA (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center; University of Florida) Boockvar KS (Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center; Icahn School of Medicine at Mount Sinai) Fan VS (VA Puget Sound Health Care System; University of Washington) Locke ER (VA Puget Sound Health Care System) Gibson B (Center for Informatics, Decision-Enhancement and Analytic Sciences, George E. Wahlen VA Medical Center; University of Utah) Mixon AS (Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System; Vanderbilt University Medical Center) Byerly SH (Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System; Vanderbilt University Medical Center) Haggstrom DA (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center; Indiana University; Regenstrief Institute, Inc.) Damush TM (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center; Indiana University; Regenstrief Institute, Inc.) Weiner M (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center; Indiana University; Regenstrief Institute, Inc.) Russ-Jara AL (Center for Health Information and Communication, Richard L. Roudebush VA Medical Center; Purdue University; Regenstrief Institute, Inc.)

Objectives:
Health information exchange (HIE), the electronic sharing of medical records between health care institutions, may increase patient safety. However, reported barriers to clinicians’ use of HIE include poor system usability and information quality. Through simulated medication reconciliation tasks, our objective was to characterize clinicians’ user experience with three HIE technologies, and to identify aspects of the technology designs related to their user experience.

Methods:
Our simulation-based observational study included three successive generations of VA’s HIE technologies: Computerized Patient Record System’s (CPRS) Remote Data View; VistA Web; and Joint Longitudinal Viewer (JLV). While using a think-aloud technique, participants attempted two randomly assigned, time-limited clinical medication reconciliation tasks using any preferred technologies. Tasks were introduced by scenarios that varied on the types of cues available about outside clinical data, ranging from 1 (no cues) to 5 (mentioning an outside specialist prescriber). To identify design-related issues with user experience, we coded usability and content problems that participants encountered while working on the medication reconciliation tasks. We assessed overall effectiveness of the HIE technologies using participants’ self-rated task ease, self-rated task success confidence, and an analyst-scored scale of task completeness. After scenarios, participants used a validated measure (UMUX-Lite) to rate each HIE technology’s ease of use and utility.

Results:
Forty-four clinicians (including 11 specialties) participated from four VA medical centers: 23 physicians, 10 pharmacists, and 11 nurse practitioners. Frequent problems identified included unclear screen layout (35 participants; 80%), difficult navigation (35 participants; 80%), and task-irrelevant data (34 participants; 77%). Overall, mean (SD) task ease (range 1–7; maximum 7) was 4.0 (1.8), confidence was 3.7 (1.8), and task success (range 0–12; maximum 12) was 9.1 (3.4). Technology ease of use and utility (range 1–7; maximum 7) were 4.0 (1.7) and 4.0 (1.6), respectively. Clinicians spent 71% of task time in CPRS, including both local and HIE components. Cues of outside care were generally associated with use of one or more HIE technologies.

Implications:
During medication reconciliation tasks, clinicians experienced barriers to effectiveness, ease of use, and utility of VA’s HIE technologies. To improve clinicians’ user experience and ease transitions to newer platforms, HIE technologies should 1) display availability of HIE clinical data, 2) minimize clinicians’ navigation steps, 3) summarize clinical data, and 4) offer searching, sorting, and filtering methods. These strategies may increase HIE’s usefulness for medication reconciliation.

Impacts:
Our findings offer direct guidance for developing HIE technologies that support clinicians’ recurring information gathering and decision making about their patients’ medications. By easing the retrieval and summarization of clinical records, our results may improve clinicians’ day-to-day experience using VA’s HIE technologies. The results are relevant to medication safety, accurate reconciliation of medication lists between VA and non-VA sources, and prevention of reconciliation-related adverse drug events among Veteran patients.