|Year : 2017 | Volume
| Issue : 1 | Page : 69-73
Hospital information system usability of educational hospitals in Isfahan using heuristic evaluation method
Saeed Saeedbakhsh1, Sakine Saghaeiannejad Isfahani1, Maede Saber2, Ghasem Yadegarfar3
1 Department of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan University, Isfahan, Iran
2 Health Information Technology, Department of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
3 School of Public Health Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||16-Jan-2017|
Department of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Aim : Considering positive effects of hospital information system (HIS) in patients' treatment and organization performance, it is necessary to evaluate the quality of services provided by these systems. Hence, this research was aimed to evaluate HIS usability after training evaluators based on heuristic method in Isfahan hospitals. Methods: This research is a practical, descriptive, and cross-sectional study, which was conducted in Isfahan educational hospitals in 2014. In this research, four evaluators assessed four HIS (Kosar, Rayavaran Tose, Pooya Samaneh Diva, Sayan) independently. Data collection tools were researcher-made check lists based on 10 Nielsen's components, which validity of the checklist was verified by faculty members, as well as medical informatics and hospital information technology specialists. Checklist not required to reliability but because of the proliferation evaluators of reliability with group training of evaluators that are involved in the process was provided. Then data were analyzed using SPSS version 20 software (IBM Company, USA). Result: The results indicated that the total of detected problems in Kosar System, Rayavaran Tose System, Pooya Samaneh Diva System, and Sayan System were %31, %34, %24, and %24, respectively. The highest number of problems with %58 was related to users' freedom and dominating the system, and the lowest number with %16 was related to the component of match between the system and the real world. Conclusion: Despite the widespread use in the country, the design of many existing health systems has usability problems, which can affect the quality of users' interaction with the system and, therefore, caring outcome. Observing available standards and regulations in designing information system user interface like mentioned components in this research can lead to problem reduction.
Keywords: Heuristic evaluation, hospital information system, usability, user interface
|How to cite this article:|
Saeedbakhsh S, Isfahani SS, Saber M, Yadegarfar G. Hospital information system usability of educational hospitals in Isfahan using heuristic evaluation method. Int J Educ Psychol Res 2017;3:69-73
|How to cite this URL:|
Saeedbakhsh S, Isfahani SS, Saber M, Yadegarfar G. Hospital information system usability of educational hospitals in Isfahan using heuristic evaluation method. Int J Educ Psychol Res [serial online] 2017 [cited 2018 Jan 19];3:69-73. Available from: http://www.ijeprjournal.org/text.asp?2017/3/1/69/180308
| Introduction|| |
At present, none of the areas of human knowledge has been far away from informatics knowledge and information technology. According to diversity and mass volume of produced data, surely healthcare structure and especially healthcare centers are not needless of this technology, and this knowledge product is a tool creation named hospital information system (HIS). This tool, by the computer aid, leads to governing a new management on healthcare centers. Reducing the caring cost, increasing care quality and healthcare services development, and also strategic consideration about earning competitive benefits can be named as this tool advantages; for this reason, applying the HISs is emphasized and the necessity of developing these systems is justified.
Despite the benefits, these systems have many problems; the most important problems of information systems include: Low transmission speed, system time-consuming, problems related to data security, and lack of standards related to message transmission.
Most of the problems are associated to these systems' usability, which leads to the problems in users' interaction with them.,,,,
Therefore, solving HISs usability problems and subsequently preventing these problems seems necessary. According to immense impact of information systems user interface design on users' interaction with the system and users' satisfaction, the results of these systems can be used for redesigning user interface and solving the main difficulties of the systems.,,,,
In a research titled "HIS quality: An evaluation tool of users' satisfaction," which was conducted by Ribiere et al., it was concluded that in order to satisfy the users of HISs, these systems should be designed based on users' comments not based on the needs and systems designers' comments.
In order that working with information systems would be satisfactory and efficient for users, a set of standard principles and regulations, related to the favorable design of information systems user interface, should be observed. One of the most well-known methods for assessment of user interface usability is heuristic method, which was presented and described by Nielsen in 1990, first. Heuristic evaluation is one of the best methods for finding usability problems.
In this method, a group of evaluators (3-5 people) is employed to assess user interface and to judge about its correspondence with predetermined standard principles.
In Nielsen method, 10 main components are applied for assessment of information systems as follows: Visibility of system; match between systems and the real world; user control and freedom; consistency and standards; error prevention; recognition rather than recall; flexibility and efficiency of use; help users recognize, diagnose, and recover from errors; esthetic and minimalist design; and help and documentation.,
In this method, the evaluators assess the user interface, independently, and evaluate observance rate of heuristic components, and nonconformity with each component is detected as usability problem that can inhibit successful user interaction with system. This method has many advantages such as ease of use and detecting most of the problems of information system user interface. So far, heuristic method has not been applied for the evaluation of HISs. According to the importance of HIS in patients' health and the necessity of using a favorable and proper user interface in this research, HISs used in educational hospitals of Isfahan were studied by heuristic method.
| Methods|| |
This research was a practical, descriptive, and cross-sectional study that assessed HISs used in four educational hospitals of Isfahan (Al Zahra, Amin, Chamran, Noor, Ali Asqar). This research was conducted from June to November, 2014.
Study population included HISs existing in 13 educational hospitals of Isfahan, from which one system, which was more complete than similar versions and was located in centers with higher referral with method of targeted nonrandom sampling was determined. Ultimately, four systems were selected as the sample including Kosar, Rayavaran Tose, Pooya Samaneh Diva, and Sayan.
In this research, no special sampling method was used for evaluators' selection. However, given that the results obtained by one evaluator are not so reliable, three to five evaluators can find over two-third of efficiency problems.
After identifying and group training evaluators, usually from them wanted to the user interface at least twice review.
For this reason, in this research, four evaluators, familiar with HISs and user interface concept, were selected.
It is noteworthy that the evaluators were justified on how to conduct the research, confidentiality of the information, and also the purpose of the research. The evaluators participated in the research with their own desire and also, all procedures were performed with permission of Isfahan University of Medical Sciences and with providing introduction letter to the hospitals.
Data collection tools were researcher-made check lists, based on 10 components proposed by Nielsen.
The validity of the check lists was confirmed according to faculty members of medical informatics and health information technology groups. Checklist not required to reliability but because of the proliferation evaluators of reliability with group training of evaluators that are involved in the process was provided.
The check lists contain two parts of general characteristics (including evaluator's name, hospital's name, HISs name, and evaluated subsystem kind) and 10 heuristic evaluation components that the questions related to each component have been designed as yes or no.
The data collected by different evaluators were compared with each other, duplicated items were removed of the total problems detected by evaluators, and similar items were determined. Then conformity of any of the problems with considered heuristic was studied by each evaluator.
The number of the evaluators who found that problem was entered against any of the found problems. Any disagreements about the found problems and assigning them to each heuristics were discussed and solved in the meetings. Then the data were analyzed using SPSS software version 20 (IBM, Armonk, NY, United States of America).
| Results|| |
HIS was studied by four evaluators using 10 components of heuristic evaluation in educational hospitals.
The distribution of each components evaluated in HIS and extracted problems according to [Table 2].
According to [Table 1] in HIS, the component of "user control and freedom," with average of 3.42 has minimum desirability and the component of "esthetic and minimalist design" and "match between system and the real world," with average of 5.1 has maximum desirability.
|Table 1: Distribution of each evaluated components in hospital information system |
Click here to view
Therefore, according to mentioned problems in HIS, this system requires the redesigning that the users can communicate more and more comfortable, and with resolving the problems, the users can access to the needed information faster and better.
| Discussion|| |
The results related to heuristic evaluation of HIS indicated that these systems had several usability problems. Some of these problems, in the case of continuation, can affect users' performance (such as fatigue, confusion, and wasting time) negatively, that it can lead to errors.
Most of the problems existing in the information systems are preventable by observing the standards and principles available for designing systems.
The results indicated that the total of detected problems in Kosar System, Rayavaran Tose System, Pooya Samaneh Diva System, and Sayan System were %31, %34, %24, and %24, respectively.
Furthermore, the results indicated that the most number of the problems was related to the component of user control and freedom, and the least number of the problems was related to the component of match between system and the real world.
These findings are not consistent with the results of the study conducted by Chan et al. The results of this study (conducted by Chan et al.) indicated that the most of the problems were related to the component of match between system and the real world.
According to the [Table 1], for component of "user control and freedom," with average of 3.42, has minimum desirability. These findings are not consistent with the results of the study conducted by Ghaderi. The results of this study indicated that features of controllability were to the 2/72 and were approximately desirable.
According to the [Table 1], for component of "esthetic and minimalist design" and "match between system and the real world," with an average of 5.1 has maximum desirability.
The results of study Khajouei indicated that 50% nonconformities were related to the component of match between system and the real world that these findings are not consistent with our result study.
These findings are consistent with the results of the study conducted by Mohajeri. The results of this study indicated that most compliance (90%) were related to the component of esthetic and minimalist design.
According to the findings of this research, these systems need to redesign that can be more consistent with Nielsen's user interface components. The increase in consistency of these databases with Nielsen's components will lead to the increase in users' perception of interface environment and as a result it will lead to the increase in usability and users' optimized interaction with these databases. The studies showed that continuous redesigning enhances system usability and helps to improve the system.
| Conclusion|| |
To benefit from the systems and information with high quality and users' satisfaction, evaluating HISs based on standard and known methods seems necessary. In data recovery systems, to establish an effective communication, what provided in interface environment of information system should be usable and comprehensible for users. However, it should be noted that understanding information systems user interface environment than other aspects of information recovery happens very slowly; part of which is, for this reason, that man is more complex than computer systems and assessing their motivations and behaviors is more difficult, and they are subjected to rapid changes.
Users own special characteristics and abilities which affect the process of interaction with the system. Therefore, the care must be taken in designing user interface which acts as an intermediary, and human characteristics should be used as a principle in designing so that the users can understand the elements and features existing in interface environment of databases easily and by which the users can communicate and interact with information system.
Using the results of this study, identified problems in the system can be solved and redesigned. According to discussed issues, heuristic evaluation is an important and effective technique for diagnosing the problems existing in health information system that this evaluation increases the quality of patients' safety and treatment by providing more accurate results and helping to identify real problems of the system.
| Suggestions|| |
The results of the study showed that the evaluation of hospital information systems as well, but recommendations for better environment user interface according to the results of the study are: To design user interface in a manner from which users' perception would be high, designers are recommended to, at first, earn general knowledge about the users' characteristics of the database by conducting preliminary studies, and then proceed to design user interface. Users' information needs assessment before designing any computerized information system to ensure compliance of information systems with user needs and usability studies done in all process of designing and developing the system.
Furthermore, it is recommended to apply the changes in proportion to problems based on each problem identified in the evaluation.
Financial support and sponsorship
The Student's Research Committee, Esfahan University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kimiyafar K, Moradi G, Sadooghi F, Sarbaz M. Views of users towards the quality of hospital information system in training hospitals affiliated to Mashhad University of Medical Sciences. J Health Inf Manage 2007;4:43-50.
Chen CH. Factors Affecting Physicians′ Use of Medical Informatic System. University of South Carolina: ProQuest; 2006.
Peute LW, Jaspers MW. The significance of a usability evaluation of an emerging laboratory order entry system. Int J Med Inform 2007;76:157-68.
Peute LW, Jaspers MM. Usability evaluation of a laboratory order entry system: Cognitive walkthrough and think aloud combined. Stud Health Technol Inform 2005;116:599-604.
Yasini M, Duclos C, Lamy JB, Venot A. Facilitating access to laboratory guidelines by modeling their contents and designing a computerized user interface. Stud Health Technol Inform 2011;169:487-91.
Khajouei R, de Jongh D, Jaspers MW. Usability evaluation of a computerized physician order entry for medication ordering. Stud Health Technol Inform 2009;150:532-6.
Horsky J, Kaufman DR, Oppenheim MI, Patel VL. A framework for analyzing the cognitive complexity of computer-assisted clinical ordering. J Biomed Inform 2003;36:4-22.
Gadd CS, Ho YX, Cala CM, Blakemore D, Chen Q, Frisse ME, et al.
User perspectives on the usability of a regional health information exchange. J Am Med Inform Assoc 2011;18:711-6.
Khajouei R, Wierenga PC, Hasman A, Jaspers MW. Clinicians satisfaction with CPOE ease of use and effect on clinicians′ workflow, efficiency and medication safety. Int J Med Inform 2011;80:297-309.
Zhang J, Johnson TR, Patel VL, Paige DL, Kubose T. Using usability heuristics to evaluate patient safety of medical devices. J Biomed Inform 2003;36:23-30.
Khajouei R, Peek N, Wierenga PC, Kersten MJ, Jaspers MW. Effect of predefined order sets and usability problems on efficiency of computerized medication ordering. Int J Med Inform 2010;79:690-8.
Ribiere V, LaSalle A, Khorramshahgol R, Gousty Y. Hospital Information Systems Quality: A Customer Satisfaction Assessment Tool. Proceedings of the 32 nd
Annual Hawaii International Conference on Issue; 1999 January 5-8; Maui (HI), USA; 1999.
Chan AJ, Islam MK, Rosewall T, Jaffray DA, Easty AC, Cafazzo JA. Applying usability heuristics to radiotherapy systems. Radiother Oncol 2012;102:142-7.
Choi J, Bakken S. Web-based education for low-literate parents in neonatal intensive care unit: Development of a website and heuristic evaluation and usability testing. Int J Med Inform 2010;79:565-75.
Nansa LG, Piri Z, Salmani E, Gholipour H, Sharghi R. Evaluation of hospital information systems in university hospitals of Tabriz University of Medical Sciences: Nurses perspectives. Health Inf Manage 2013;10:190-200.
Khajouei R, Azizi AA, Atashi A. Usability evaluation of an emergency information system: A heuristic evaluation. Health Manage 2013;16:61-72.
Mohajeri F, Mohamadsalahi R. Evaluation feature and constituent elements Resa: Comprehensive software library, Documentation center and archive user interface. Knowl Q 2009;2:75-87.
[Table 1], [Table 2]