gms | German Medical Science

Background and Motivation: Hospital information systems (HISs) have become widely used worldwide. Current HISs show remarkable performance and offer many functions with regard to patient treatment. However, physicians and nurses must gather and input all patient data electronically. To help medical providers save time and labor related to the operation of HISs, it is important to equip such systems with a superior user interface (UI).

To this end, we investigated HIS UIs internationally. In this pilot study, we analyzed the UIs of six hospitals in two different countries using objective measurements, with a focus on laboratory orders.

Methods: We investigated the UIs of six hospitals in Japan and in Germany. Four were university hospitals and the others were municipal medical centers. We measured three parameters related to UI performance: the number of steps in the laboratory order workflow, KLM-GOMS, Fitts’ law score, the latter two of which are well-known objective measures of UIs [1]. The lab order we used consisted of LDH, AST, ALT, gamma-GT, total Bilirubin, Potassium, Sodium, Creatinine, CRP and blood cell count. We recorded all ordering processes with a video camera and captured each screen-shot.

Results: The workflows of the laboratory orders were similar among HISs. However, the parameters differed in each HIS. The number of steps necessary to complete an order ranged from 15 to 21 (average, 17.5). The KLM-GOMS score ranged from 21.25 to 27.25 (average, 24.47), and the Fitts’ law score ranged from 33.60 to 41.43 (average, 37.67). Smaller values are better in these scores.

Discussion: There were differences in the parameters among HISs despite similar workflows. Thus, there is room to improve these HIS UIs by reference to features of other HISs. In fact we found considerable ingenuity in each HIS. For example, to decrease the necessary steps, the window of serum chemistry, which is frequently used, is shown at the same time as the start of laboratory order. Another example is customizing the system to automatically return to the main window of the program after the user chooses “save orders”.

The results of the KLM-GOMS and Fitts’ law scores can also be used to improve the HIS UIs. For example, by simply optimizing the position of the button for “fix order items”, the Fitts’ law score at one hospital could be improved from 41.43 to 37.71.

Our study has some limitations. In many hospitals, physicians often use standard order sets. Hence, the present results may not apply directly to some clinical settings because we could not consider order sets in this study. Nonetheless, we believe that our findings could be used to improve UIs that include order sets.

Conclusion: We analyzed UIs of six hospitals and showed one of the methods how to evaluate and improve HIS UI.

Acknowledgement: We thank our colleagues of the Center for Information Management (ZIMt) of Hannover Medical School (Mr. May, Dr. Schulz, Mrs. Märker-Lezius, Mr. Badke and Mr. Weber) and the IT center of Braunschweig Medical Center (Dr. Seidel, Mr. Schneider-Adamek).