Ch 5: Human-Computer Interaction in Biomedical Informatics

• Human-computer interaction (HCI) explores how people interact with technology and how to design user-friendly systems.
• Poorly designed interfaces can frustrate users and lead to inefficiencies and safety risks in healthcare.
• Investing in usability early in development is more cost-effective than fixing problems later.
• HCI aims to align systems with how people think and work, boosting efficiency and satisfaction.
• HCI has spurred innovations in virtual reality, mobile apps, and collaborative workspaces.
• Nearly 50% of software code is dedicated to the user interface.
• Usability testing has become a standard part of development.
• HCI helps design systems that support clinical workflows, improve decision-making, and enhance patient safety.

Role of HCI in Biomedical Informatics

• HCI enhances health information technologies (HIT) like electronic health records (EHRs).
• HCI research now examines how teams and organizations interact with technology, not just individuals.
• Poorly designed systems like computerized provider order entry (CPOE) can cause errors.
• HCI works to make systems usable, useful, and safe, addressing shortfalls in HIT's potential.
• HCI studies how healthcare teams use EHRs to coordinate care using distributed systems.

Theoretical Foundations

• Technology Acceptance Model (TAM) focuses on perceived usefulness and ease of use.
• Sociotechnical Systems Theory views organizations as systems of technology, people, and external factors.
• Cognitive Engineering combines cognitive science and engineering to design systems supporting human performance.
• Distributed Cognition (DCog) examines how cognition is spread across people, tools, and environments.
• These theories help design technology that fits seamlessly into clinical workflows.
• In hospitals, doctors, nurses, and EHRs all contribute to decision-making.
• These theories help researchers understand how technology mediates human work.

Usability of Health Information Technology

• Usability reflects how easy and effective a system is to use, measured by learnability, efficiency, memorability, errors, and satisfaction.
• Learnability is how easy it is to learn a system
• Efficiency is how quickly experienced users can perform tasks.
• Memorability is how easy it is to remember how to use the system.
• Errors is how well the system prevents and helps users recover from mistakes.
• Satisfaction is how pleasant the system is to use.

Usability Evaluation Methods

• Analytical approaches involve experts evaluating systems without end users through task analysis, heuristic evaluation, and cognitive walkthroughs.
• User-based testing involves real users and includes methods like interviews, focus groups, think-aloud protocols, surveys, and questionnaires.
• Task analysis involves breaking down tasks into smaller steps to identify potential issues.
• Heuristic evaluation consists of experts checking the system against usability principles, like consistency and error prevention.
• Cognitive walkthroughs involve simulating user tasks to identify usability problems.

Clinical Workflow

• Workflow is the sequence of tasks and processes needed to achieve a goal, like patient care.
• EHRs can either support or disrupt workflows.
• Documentation burden, navigation complexity, and information overload are challenges with EHR workflows.
• Medication reconciliation tools, predictive models, and field studies can improve workflow with HCI.
• Healthcare workflows are complex and often involve multiple providers, high workloads, and frequent interruptions.
• Clinicians spend significant time entering data into EHRs, reducing time for patient care because of documentation burden.
• Poorly designed interfaces require too many clicks or screen transitions, increasing cognitive load.
• Cluttered screens and excessive alerts can overwhelm users, leading to errors
• Well-designed medication reconciliation tools can reduce errors by making it easier to compare and update medication lists.
• Tools like the Keystroke-Level Model (KLM) predict how long tasks will take, helping identify inefficiencies.
• Observing clinicians in real-world settings reveals how systems impact workflows and patient care through field studies.

Future Directions

• Future HCI research includes unobtrusive evaluation using data from EHR logs and eye-tracking.
• Designing easy-to-use consumer-facing applications, such as mobile apps and patient portals, is important.
• Collaborative design brings clinicians, designers, and researchers together to create effective systems.
• Future areas for research include using data from EHR logs, eye-tracking, and other sources to study user interactions without disrupting workflows.

Key Takeaways

• HCI focuses on designing systems that are easy to use, efficient, and aligned with human cognitive abilities
• Usability is critical in healthcare, where poorly designed systems can lead to errors and inefficiencies
• Workflow Analysis helps identify how technology impacts clinical tasks and how to design systems that support, rather than disrupt, workflows
• Data-driven methods to evaluate usability and designing consumer-facing tools for patient engagement are future trends.
• Applying HCI principles helps create healthcare technologies that improve efficiency, safety, and user satisfaction.