User-Centered Design and Evaluation of Health Information Systems: A Rapid Usability Engineering Approach

The usability of health information systems has continued to be an issue in health informatics. Many health information systems that have been deployed worldwide have been deemed unusable, not fitting clinical workflow, and in some cases rejected by end users. Along these lines, there is also growing evidence that poorly designed user interfaces may lead to increased cognitive load, may negatively impact workflow, which could impede cognitive processes involved in decision making and reasoning. In this chapter, we describe work in applying user-centered design principles in conjunction with advances in usability engineering to improve the usability of health information systems so that they augment and support human cognition and work activities. Several approaches are described from the application of laboratory style usability testing to the use of clinical simulations conducted “in-situ” in real-world healthcare settings. These approaches can be used to improve the usability of a range of healthcare systems. As will be described the methods can be used to assess the impact of systems on healthcare cognitive processes, including impact on clinical reasoning and decision making. We also discuss how low-cost rapid usability engineering methods can be applied throughout the design and implementation cycle of health information systems to improve system adoption. In addition to this, emerging approaches to testing health information systems will be described, including remote and large-scale usability analyses.