Comparison of Two Electronic Order Forms for Medical Consultation: Think-Aloud Usability Assessment With Referring Clinicians

摘要

Due to its early role in the medical referral process, the consultation order is a focal point for breakdowns in communication about referrals. Both referrers and consultants agree that the current approach to referral communication is flawed, and poor usability of electronic health record (EHR) user interfaces (UIs) is a contributing factor (Mehrotra, Forrest, & Lin, 2011; O’Malley & Reschovsky, 2011; Zuchowski et al., 2015). To improve EHR UIs for ordering consultations, experts have recommended including these features: a list of consulting services, integrated clinical information (e.g., relevant diagnostic test results), referral guidelines (e.g., when not to order a consultation), clear options for communicating urgency (e.g., urgent or routine), and multiline free-text fields, including one field to indicate the reason for consultation (Bergus, Emerson, Reed, & Attaluri, 2006; Esquivel, Sittig, Murphy, & Singh, 2012; Militello et al., 2016). Our objective was to assess users’ reactions to these recommendations with a comparative usability evaluation. We designed a UI prototype for consultation orders that incorporated the aforementioned recommendations. We hypothesized that the prototype would elicit more positive comments about its usability than would the UI of a currently available EHR (a control UI).