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

^a Veterans Association Getting at Patient Safety (GAPS) Center, VAMC, Cincinnati, OH
^b Veterans Association HSR&D Center on Implementing Evidence-based Practice, Roudebush VAMC, Indianapolis, IN
^c Department of Electrical and Computer Engineering, IUPUI, Indianapolis, IN
^d Institute for Ergonomics, The Ohio State University, Columbus, OH
^e Cognitive Systems Engineering Laboratory, The Ohio State University, Columbus, OH
^f University of Dayton Research Institute, Dayton, OH
^g Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
^h Roth Cognitive Engineering, Brookline, MA
ⁱ Health Services Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA
^j Associate Professor of Medicine at the David Geffen School of Medicine, UCLA, Los Angeles, CA.

^_* Correspondence and reprints: Jason J. Saleem, PhD, VA HSR&D Center of Excellence on Implementing Evidenced-Based Practice (CIEBP), Richard L. Roudebush VA Medical Center (11-H), 1481 West Tenth Street, Indianapolis, IN 46202 (Email: jsaleem{at}iupui.edu).

Received for publication: 05/28/06; accepted for publication: 06/11/07.

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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