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. 2021 Jul 14;28(7):1401-1410.
doi: 10.1093/jamia/ocab016.

Human-centered development of an electronic health record-embedded, interactive information visualization in the emergency department using fast healthcare interoperability resources

Jeritt G Thayer  1 , Daria F Ferro  1   2   3 , Jeffrey M Miller  1 , Dean Karavite  1 , Robert W Grundmeier  1   2   3 , Levon Utidjian  1   2   3 , Joseph J Zorc  1   2   4
Affiliations

Human-centered development of an electronic health record-embedded, interactive information visualization in the emergency department using fast healthcare interoperability resources

Jeritt G Thayer et al. J Am Med Inform Assoc. .

Abstract

Objective: Develop and evaluate an interactive information visualization embedded within the electronic health record (EHR) by following human-centered design (HCD) processes and leveraging modern health information exchange standards.

Materials and methods: We applied an HCD process to develop a Fast Healthcare Interoperability Resources (FHIR) application that displays a patient's asthma history to clinicians in a pediatric emergency department. We performed a preimplementation comparative system evaluation to measure time on task, number of screens, information retrieval accuracy, cognitive load, user satisfaction, and perceived utility and usefulness. Application usage and system functionality were assessed using application logs and a postimplementation survey of end users.

Results: Usability testing of the Asthma Timeline Application demonstrated a statistically significant reduction in time on task (P < .001), number of screens (P < .001), and cognitive load (P < .001) for clinicians when compared to base EHR functionality. Postimplementation evaluation demonstrated reliable functionality and high user satisfaction.

Discussion: Following HCD processes to develop an application in the context of clinical operations/quality improvement is feasible. Our work also highlights the potential benefits and challenges associated with using internationally recognized data exchange standards as currently implemented.

Conclusion: Compared to standard EHR functionality, our visualization increased clinician efficiency when reviewing the charts of pediatric asthma patients. Application development efforts in an operational context should leverage existing health information exchange standards, such as FHIR, and evidence-based mixed methods approaches.

Keywords: clinical decision support systems; health information exchange; health information interoperability; human-centered design; implementation science.

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Figures

Figure 1.
Figure 1.
Human-centered design process for application development.
Figure 2.
Figure 2.
Production version of the Asthma Timeline Application embedded in the EHR with synthetic patient data.
Figure 3.
Figure 3.
Box plot of NASA TLX results.
See this image and copyright information in PMC

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