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Work Group 1

Page history last edited by Christel Anderson 11 years, 8 months ago

Work Group 1

TIGER Usability & Clinical Application Design



Working together using this wiki


This wiki is a shared online whiteboard that allows the entire group to easily share information to each other and other TIGER collaborative team members. The material on the wiki should be considered to be in draft format and will be published on the TIGER website at www.tigersummit.com upon completion. 


Activities of Work Group 1


This work group is collecting a list of pertinent resources for nurses to use in developing requirements for better usability and clinical application design.  These resources will initially be collected from within nursing, healthcare, and other industries.  These resources may include published material, subject matter experts, and ongoing programs to watch. 


Group members


  • Kathleen Smith - Facilitator
  • Donna Bailey
  • Nicole Barker
  • Kandis Gillis
  • Vicki Morgan-Cramer
  • Troy Seagondollar
  • Brian Stever  
  • Constance Johnson
  • Marisa Wilson
  • Victoria Bradley
  • Susan Boedefeld
  • Carol Chau


Completed Literature analysis 

type_xls.gifHuman Factors Lit rev analysis_worksheet ks.xls - by Kathleen Smith



Technology Drill Down Project - see the American Academy of Nursing's website at http://www.aannet.org/i4a/pages/index.cfm?pageid=3318



The Robert Wood Johnson Foundation (RWJF) awarded a grant to the American Academy of Nursing in December of 2005 for a project called "Technology Targets: A Synthesized Approach for Identifying and Fostering Technological Solutions to Workflow Inefficiencies on Medical/Surgical Units."  


A major component of Technology Targets is a process called Technology Drill Down (TD2), which represents an opportunity to develop an improved process for identifying technological solutions to medical/surgical unit workflow inefficiencies. Twenty-five hospitals and health care systems participated as a TD2 site between March of 2006 and May of 2007. All of the sites found the process to be beneficial in identifying workflow issues and areas most ripe for technological fixes as well as process improvements. The study is currently in the data analysis phase and a presentation of findings will be shared at the 2007 AAN Annual Conference in November.


The Technology Drill Down process focuses on medical/surgical unit workflow from a systems-wide or global perspective rather than a unit perspective. It engages not only RNs, assistive personnel, and unit clerks but also department members from across the entire health care team (including, for example, pharmacy, materials management, social work, and respiratory therapy) whose work processes interface and are interrelated: they all impact patient care and delivery. This interdisciplinary perspective provides a unique opportunity for looking at and analyzing these processes to see where and how they can be improved to create more efficient health care environments. Moreover, the process allows for the involvement of key decision makers such as chief nursing officers and chief information officers as well as environmental experts, clinical engineers, human factor's engineers, and architects before time and financial investments in technologies are made that so that they can be informed by the day-to-day realities faced by frontline staff.


The American Academy of Nursing has now made the Technology Drill Down process available for all hospitals to facilitate through a TD2 DVD and Facilitator's Manual.




  1. Books
  2. Articles
  3. Chapters in Books
  4. Websites/URLs
  5. Conference Proceedings
  6. Bibliographies


List of references provided by Janey Barnes, PhD, Human Factors Specialist on 11/15/07


Designing Usability Into Medical Products Michael E. Wiklund and StephenB. Wilcox CRC Press, 2005


Human Error in Medicine, Ed. Marilyn Sue Bogner, LEA, 1994 Includes chap. "Medical devices, medical errors and medical accidents" by John Senders, pp 159-178, as well as many other chapters related to usability of medical devices.


Reviews of Human Factors and Ergonomics, Volume 1, Ed. Raymond S. Nickerson,

HFES, 2006 Includes section "Reducing and Mitigating Human Error in Medicine", by

Daniel Morrow, Robert North, & Christopher D. Wickens


Human Factors: The Journal of the Human Factors and Ergonomics Society, 48 (1), 2006 contains a special section describing ways in which human factors/ergonomics professionals are improving health care. Some articles focus on usability aspects of medical devices.


The FDA also has some useful resources: http://www.fda.gov/

The Association for the Advancement of Medical Instrumentation (www.aami.org) published "Human factors design process for medical devices" (ANSI/AAMI HE74:2001). Steve and Mike were both contributors to this standard, too.


References provided by Constance M. Johnson, Ph.D., R.N.  

type_doc.gifUsability References.doc  


Two articles addressing the importance of clinical design in information systems. Contributed by Michelle Troseth.

Clin Doc article in HCT Vol1.pdf

IDA Article in HCT Vol2.pdf




provided by Kathleen Smith, MScEd, RN-BC, FHIMSS on 11/27/07


Healthy Computing: http://www.healthycomputing.com/

Usability and Design: http://www-128.ibm.com/developerworks/spaces/usability



type_doc.gifReferences for Medical Design.doc 


Potential Categories for framework

2/14/08 - posted by Nancy Staggers

We may want to inductively develop these categories.  Here's a start:
Descriptions of usability Issues with applications,design
Theoretical works in HCI, usability (models, frameworks)
Usability Methods
Usabiity/application design principles, heuristics
Empirical Research findings
Add/edit prn

3/5/08 - posted by Jane Brokel

type_pdf.gifRT-0156-Usability critieria.pdf

This attached document may help us in identifying the categories. When you look at the Attachment -- you will find the subcategories to help us. pull into these categories.   This was from 1993 work by Bastien and Scapin.   I used this criteria for evaluating a system and it helps evaluation.   


The 8 categories for HCI


   1. Guidance

   2. Workload

   3. Explicit Control

   4. Adaptability

   5. Error Management

   6, Consistency

   7. Significance of Codes

   8. Compatibility


Look at all the subcategories with each of these categories.


3/5/2008 - Provided by  Constance M. Johnson, Ph.D., R.N.

Zhang, J., & Butler, K. (2007). UFuRT: A work-centered framework and process for design and evaluation of information systems.

type_pdf.gifZhang-Butler_UFuRT-InterHCI2007.pdf  Proceedings of HCI International 2007.
Provided by Constance Johnson, Ph.D., R.N. on 3/7/2008
As per our conversation on Wednesday and organizing the references, I would suggest organizing it by the usability engineering lifecycle. I would keep this very high level.  What was discussed the other day was too granular and would be very confusing to most people.   So the topic headings could include:

Human-Computer Interaction Theories or Human Factors Theories

Human Information Processing

Information, Representation, and Visualization

Hardware - input/output technologies

Requirements Analysis

        Representational Analysis

        Functional Analysis

        User Analysis

        Task Analysis

        Environmental Analysis

Usability Design

Usability Development

Usability Testing 


Provided by Michelle Troseth 3/14/2008

type_none.gifOrganizaing Framework for CIS-Clinical Knowledge as Critical Factor.ppt

type_none.gifProfessional Practice Framework for HIT Adoption and Healthcare Transformation.ppt

Hi Everyone –

I cannot join the call today due to an all day meeting I am in to discuss and recommend an organizing framework for our synthesis and recommendations.  I reviewed what was posted on the WIKI and had some feedback/suggestions I wanted to share.


I think the 2 documents posted covered the technical/ergonomics aspects of Usability and Clinical Design – my concern is they do not address critical aspects of usability and clinical design that support the practice of the user/bedside nurse.  I believe the organizing framework must have a balance of both the technical and practice aspects of Usability and Clinical Design.


For example:  The HCI document – addresses “guidance” on how the user interacts with the computer – I would also like to see criteria/components on how it provides the user in interacting with the patient and other care givers, how it provides guidance in patient care decisions and knowing critical, real-time information about the patient. 

The “prompting” is focused primarily on the computer/technology as well – good prompting helps them navigate in the application – which is important, but what about prompting for evidence-based interventions, critical thinking, patient evaluation, etc.


The 2nd posted document (Zhang-Butler) is focused primarily on the technical aspects – it would be helpful for someone who is very familiar with this to walk me through it.  There were some good criteria listed in the fist paragraph (the things that need to be addressed due to the high rate of failure).


I am attaching a couple of other references that I would like to add to the mix so we can have a more balanced organizing framework:


1.Androwich, I.M., Bickford, C.J., Button, P.S., Hunter, K.M., Murphy, J., & Sensmeier, J. Clinical Information Systems: A Framework for Reaching the Vision. 2003, Washington, D.C.: American Nurses Association.

One organizing framework if from this ANA publication with many of our TIGER Colleagues – the benefit of this is it addresses Professional Practice, Clinical Knowledge, etc.


2.Belmont, C.J., Wesorick, B., Jesse, H., Troseth, M. R., & Brown, D. (2003). Clinical Documentation. Health Care Technology: Innovating Clinical Care Through Technology, 2003. San Francisco: Montgomery Research, Inc., 183-186.

3.Wesorick, B., Troseth, M., Cato, J.  Intentionally Designed Automation Creates the Best Places to Work and Receive Care.  Health Care Technology:  Innovating Care Through Technology, 2004, 2. San Francisco: Montgomery Research, Inc., 3-7.


The CPM Professional Practice Framework is referenced in articles 2 & 3, as well as the TIGER Report – and has distinct components that address practice interoperability via a practice framework and technology.  I attached a visual of the Framework and the Principles of Intentionally Designed Clinical Tools/Automation.


So I would like to add categories of:

  • Supports Evidence-based Practice

  • Provides Clinical Decision Support

  • Supports Professional Practice

  • Supports Interdisciplinary Integration


to some of the other criteria in the posted documents and Nancy’s suggestions below.

Potential Categories for framework

2/14/08 - posted by Nancy Staggers

We may want to inductively develop these categories.  Here's a start:


Descriptions of usability Issues with applications,design

Theoretical works in HCI, usability (models, frameworks)

Usability Methods

Usabiity/application design principles, heuristics

Empirical Research findings



Wish I could be on the call today – please let me know who it goes!  This is very important work to help shape our deliverable…



Michelle R. Troseth, RN, MSN






January 29, 2008 at 12 noon EST

Call 1-866-516-5393 and enter access code 34694710


February 5, 2008 at 12 noon EST

Call 1-866-516-5393 and enter access code 34694710


February 12, 2008 at 12 noon EST

Call 1-866-516-5393 and enter access code 34694710


Update from Kathleen Smith on 2/13/08


Hello all,

We haven't had much luck withour conference calls.  I did have the moderator's code for today's call, but perhaps we were overcome by events (or forgot!)

Anyway, we have the wonderful work that Greg did for terms to use for a literature search, and now we need to develop a plan on how to use this information.  Marisa Wilson is working on updating the search terms with a search from 2005-2008. Michelle Troseth contributed two articles on the importance of clinical design in information systems, and we have a number of other references and citations on our Wiki.

Our next step is to divide this material into workable groups, with perhaps some guidance for various groups on search strategies for usability.

Nancy and Michelle, could you help us create a framework so we can dive into all this excellent material?

Team, can we do our collaborative work via e-mail?

I'm open to other suggestions on how to finish "our assignment".

Thanks all,

Kathleen Smith


Usability References and Resources


type_doc.gifReferences for Medical Design.doc


type_doc.gifUsability References 2007.doc


Additional resources posted by Melita Howell 

http://www.fda.gov/cdrh/humfac/doit.html - Do It By Design - An Introduction to Human Factors in Medical Devices
http://www.v-chi.dk/HFEinHI2007/index.php?page=forside - Human Factors Engineering in Health Informatics 2007 session - click link at top of page for proceedings - note table of contents attached

Resources and Postings

Provided by Greg Alexander - type_xls.gifRelated Terms to HF_rev.xls

This is an indexed list of search terms for literature search


Terms to use for literature searches - provided by Kathleen Smith

*Please give us feedback and add terms


human technology interaction,

usability and clinical systems


HCI (human computer interaction)

human computer interface


Human Factors

And Nursing

And Informatics

And workflow

Thought flow

Usability training

Usability testing

User acceptance testing

Clinical application design


(Negative search where applications don't work)

Adoption gone bad

Implementation gone bad

Lessons learned

Effective use

Nursing adoption of IT


Bad Design of Clinical Application


Humorous examples


Search on people of usability and clinical design

Subject matter experts


Added ergonomics and computers literature review spreadsheet in the files section. Kathleen Smith





Comments (3)

Anonymous said

at 11:58 am on Oct 31, 2007

I am a member of CAST, The Centers for Aging Services Technology which has been working on the interoperability and Electronic Health Records information from the aging and Long Term Care perspective. Their website is http://www.agingtech.org/index.aspx . I will add more in the near future.

Anonymous said

at 5:02 pm on Nov 2, 2007

Here are some references and resources for usability and design.

Saba, V.K. & McCormick, K. (2001). Essentials of computers for nurses: Informatics for the new millennium (3rd ed.). McGraw-Hill:NY. pp. 73-74.

Thede, L.Q. (1999). Computers in nursing: Bridges to the future. Lippincott:Philadelphia. p. 221.

Dennis, A. & Wixom, B.H. (2003). Systems analysis and design (2nd ed.). John Wiley & Sons, Inc.: USA. pp. 303-353

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