In this paper, we discuss the user-centered design (UCD) strategies we employed to design an electronic health record (EHR)-integrated application for documentation and tracking of guideline-directed medical therapy for patients with heart failure with reduced ejection fraction. We designed this clinician-facing application by engaging heart failure clinicians, patients and family members, and technology experts. We report on these strategies that, while not uncommon for patient-facing technologies, are less often seen for the design and evaluation of clinician-facing EHR applications. We also provide suggestions for practitioners seeking to build EHR applications and propose avenues for future research.
References
1.
AllenL. A.VenechukG.McIlvennanC. K.. . . MatlockD. D. (2021). An electronically delivered patient-activation tool for intensification of medications for chronic heart failure with reduced ejection fraction. Circulation, 143(5), 427-437. doi:10.1161/circulationaha.120.051863
2.
BenderD.SartipiK. (2013). HL7 FHIR: An Agile and RESTful approach to healthcare information exchange. Proc IEEE Int Symp Comput Based Med Syst, Porto, Portugal.
3.
BlandfordA.GibbsJ.NewhouseN.. . . MurrayE. (2018). Seven lessons for interdisciplinary research on interactive digital health interventions. DIGITAL HEALTH, 4. doi:10.1177/2055207618770325
4.
BorsciS.BuckleP.WalneS. (2020). Is the LITE version of the usability metric for user experience (UMUX-LITE) a reliable tool to support rapid assessment of new healthcare technology?Appl Ergon, 84, 103007. doi:10.1016/j.apergo.2019.103007
5.
BrookeJ. (1996). SUS: a 'quick and dirty' usability scale. In JordanP. W.ThomasB.LyallI. (Eds.), Usability Evaluation in Industry (pp. 189-194). Taylor & Francis.
6.
CornetV. P.CharlesM.ToscosT. (2023). Simulation Modeling for Health Care Operations: User-centered Design Needed!Proc Hum Factors Ergon Soc Annu Meet, 0(0), 21695067231192438. doi:10.1177/21695067231192438
7.
CornetV. P.DaleyC.BolchiniD.. . . HoldenR. J. (2019). Patient-centered design grounded in user and clinical realities: Towards valid digital health. Proc Int Symp Hum Factors Ergon Healthc, 8(1), 100-104. doi:10.1177/2327857919081023
8.
CornetV. P.ToscosT.BolchiniD.. . . HoldenR. J. (2020). Untold stories in user-centered design of mobile health: practical challenges and strategies learned from the design and evaluation of an app for older adults with heart failure. JMIR Mhealth Uhealth, 8(7), e17703. doi:10.2196/17703
9.
CornetV. P.VoidaS.HoldenR. J. (2017). Activity Theory Analysis of Heart Failure Self-Care. Mind, Culture, and Activity, 1-18. doi:10.1080/10749039.2017.1372785
10.
DaleyC.Rohani GhahariR.DrouinM.. . . MirroM. (2020). Involving patients as key stakeholders in the design of cardiovascular implantable electronic device data dashboards: Implications for patient care. Heart Rhythm O2, 1(2), 136-146. doi:10.1016/j.hroo.2020.04.005
11.
DoberneJ. W.KakadayR.ReddT. K.. . . ChiangM. F. (2015). Barriers to Information Access in Electronic Health Records during Initial Patient Visits: A Qualitative Study. Proc Int Symp Hum Factors Ergon Healthc, 4(1), 143-149. doi:10.1177/2327857915041009
12.
GarabedianP. M.GannonM. P.AaronS.. . . SamalL. (2022). Human- centered design of clinical decision support for management of hypertension with chronic kidney disease. BMC Med Inform Decis Mak, 22(1), 217. doi:10.1186/s12911-022-01962-y
13.
GreeneS. J.ButlerJ.AlbertN. M.. . . FonarowG. C. (2018). Medical Therapy for Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol, 72(4), 351-366. doi:10.1016/j.jacc.2018.04.070
14.
HoldenR. J.BinkhederS.PatelJ.ViernesS. H. P. (2018). Best practices for health informatician involvement in interprofessional health care teams. Appl Clin Inform, 09(01), 141-148. doi:10.1055/s-0038-1626724
15.
HoldenR. J.CarayonP.GursesA. P.. . . Rivera-RodriguezA. J. (2013). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11). doi:10.1080/00140139.2013.838643
16.
HoldenR. J.CornetV. P.ValdezR. S. (2020). Patient ergonomics: 10- year mapping review of patient-centered human factors. Appl Ergon, 82, 102972. doi:10.1016/j.apergo.2019.102972
17.
HoldenR. J.KulanthaivelA.PurkayasthaS.. . . KripalaniS. (2017). Know thy eHealth user: Development of biopsychosocial personas from a study of older adults with heart failure. Int J Med Inform, 108, 158-167. doi:10.1016/j.ijmedinf.2017.10.006
18.
LewisJ. R.UteschB. S.MaherD. E. (2013). UMUX-LITE: when there's no time for the SUSProc SIGCHI Conf Hum Factor Comput Syst, Paris, France. doi:10.1145/2470654.2481287
19.
MaddoxT. M.JanuzziJ. L.AllenL. A.. . . YoumansQ. R. (2021). 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol, 77(6), 772-810. doi:10.1016/j.jacc.2020.11.022
20.
MelnickE. R.HollandW. C.AhmedO. M.. . . SoladY. (2019). An integrated web application for decision support and automation of EHR workflow: a case study of current challenges to standards-based messaging and scalability from the EMBED trial. JAMIA Open, 2(4), 434-439. doi:10.1093/jamiaopen/ooz053
21.
NguyenK. A.PatelH.HaggstromD. A.. . . RussA. L. (2019). Utilizing a user-centered approach to develop and assess pharmacogenomic clinical decision support for thiopurine methyltransferase. BMC Med Inform Decis Mak, 19(1), 194. doi:10.1186/s12911-019-0919-4
22.
NiY.BachtelA.NauseK.BealS. (2021). Automated detection of substance use information from electronic health records for a pediatric population. J Am Med Inform Assoc, 28(10), 2116-2127.
23.
RayJ. M.AhmedO. M.SoladY.. . . MelnickE. R. (2019). Computerized Clinical Decision Support System for Emergency Department–Initiated Buprenorphine for Opioid Use Disorder: User-Centered Design. JMIR Hum Factors, 6(1), e13121. doi:10.2196/13121
24.
ReichheldF. (2007). The Ultimate Question: Driving Good Profits and True Growth. Findaway World.
25.
RobertsonR.AhmedR.ToscosT.. . . MirroM. (2020). Technology and workflow recommendations to improve use of guideline directed medical therapy for heart failure with reduced ejection fraction.
26.
RomanoN.NunamakerJ. (2001). Meeting Analysis: Findings from Research and Practice.
27.
RoseA. F.SchnipperJ. L.ParkE. R.. . . MiddletonB. (2005). Using qualitative studies to improve the usability of an EMR. J Biomed Inform, 38(1), 51-60. doi:10.1016/j.jbi.2004.11.006
28.
RudinR. S.PerezS.RodriguezJ. A.. . . DalalA. K. (2021). User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care. J Am Med Inform Assoc, 28(11), 2433-2444. doi:10.1093/jamia/ocab157
29.
SaitwalH.FengX.WaljiM.. . . ZhangJ. (2010). Assessing performance of an Electronic Health Record (EHR) using Cognitive Task Analysis. Int J Med Inform, 79(7), 501-506. doi:10.1016/j.ijmedinf.2010.04.001
30.
SamskyM. D.LevertyR.GrayJ. M.. . . DeVoreA. D. (2023). Patient perspectives on digital interventions to manage heart failure medications: the VITAL-HF pilot. J Clin Med, 12(14), 4676.
31.
ShahS.MorrisA. O.StoneJ. A.ChuiM. A. (2020). Older adult shopping persona types and its impact on over-the-counter medication misuse. Proc Int Symp Hum Factors Ergon Healthc, 9(1), 124-128. doi:10.1177/2327857920091046
32.
ThayerJ. G.FerroD. F.MillerJ. M.. . . ZorcJ. J. (2021). Human-centered development of an electronic health record-embedded, interactive information visualization in the emergency department using fast healthcare interoperability resources. J Am Med Inform Assoc, 28(7), 1401-1410. doi:10.1093/jamia/ocab016
33.
ValadriR.LitchmanM.SpringD.. . . PancholyS. B. (2017). A Study to Assess Limitations in the Adherence to 2013 American College of Cardiology Foundation or American Heart Association Practice Guideline for Management of Heart Failure in Primary Care [Mini Review]. J Fam Med Community Health. doi:10.47739/2379-0547/1101
34.
YeltonB.RumthaoJ. R.SakhujaM.. . . FriedmanD. B. (2023). Assessment and Documentation of Social Determinants of Health Among Health Care Providers: Qualitative Study. JMIR Form Res, 7, e47461. doi:10.2196/47461
35.
ZahabiM.KaberD. B.SwangnetrM. (2015). Usability and Safety in Electronic Medical Records Interface Design:A Review of Recent Literature and Guideline Formulation. Hum Factors, 57(5), 805-834. doi:10.1177/0018720815576827
