The doctoral dissertations of the former Helsinki University of Technology (TKK) and Aalto University Schools of Technology (CHEM, ELEC, ENG, SCI) published in electronic format are available in the electronic publications archive of Aalto University - Aaltodoc.
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Usability in Healthcare: Overcoming the Mismatch Between Information Systems and Clinical Work

Johanna Kaipio (née Viitanen)

Doctoral dissertation for the degree of Doctor of Science in Technology to be presented with due permission of the School of Science for public examination and debate in Auditorium T2 at the Aalto University School of Science (Espoo, Finland) on the 4th of November 2011 at 12 noon.

Overview in PDF format (ISBN 978-952-60-4334-0)   [2657 KB]
Dissertation is also available in print (ISBN 978-952-60-4333-3)

Abstract

Usability of clinical information technology (IT) systems is an ongoing topic of discussion. The systems should support healthcare professionals in their daily work with patients. However, critics indicate the prevalence of negative experiences and use related problems.

The overall goal of the thesis is to examine the usability of current clinical IT systems from the viewpoint of physicians and nurses for the purposes of further user-centred system development. The thesis includes three empirical studies: a digital dictation study, evaluation of nursing documentation systems, and a national usability questionnaire study with physicians. The research was carried out utilizing contextual inquiry, interaction sequence illustration analysis, and tailored usability questionnaire methods.

The research resulted in the following findings and conclusions.

Currently used IT systems do not support the daily work and clinical tasks of clinicians well. This is due to numerous usability problems, and lack of computer support for multi-professional and cross-organizational collaboration between clinicians. Major improvements are needed to achieve the potential benefits clinical information and communication technology systems offer. Based on empirical studies, themes for potential improvements are: development of efficient and mobile documentation solutions, redesign of system user interfaces, solutions to support communication and collaboration, customisable and context-specific clinical IT systems, and conceptual redesign of nursing documentation system.

In the field of health informatics, a need exists to broaden the scope of usability work. Usability is closely associated with evaluation and testing activities instead of design activities. Hence, the scope of usability is more restricted than it is in user-centred design and usability research fields. In order to overcome the current mismatch between IT systems and clinical work, it is important to understand that usability is extremely context-sensitive by nature.

The study results indicated shortcomings in user-centred healthcare IT systems design and end-users' abilities to contribute to development work. User-centred design methods provide a variety of means to analyse, design, and evaluate information and communication systems for clinical purposes. However, the characteristics of the clinical context (e.g. privacy and data security issues, and the wide range of IT systems in use) need to be taken into account when applying the methods and performing research in real-life clinical surroundings.

This thesis consists of an overview and of the following 6 publications:

  1. Johanna Viitanen. 2009. Redesigning digital dictation for physicians: A user-centred approach. Health Informatics Journal, volume 15, number 3, pages 179-190. © 2009 by author.
  2. Johanna Viitanen, Anne Kuusisto, and Pirkko Nykänen. 2011. Usability of electronic nursing record systems: Definition and results from an evaluation study in Finland. In: Elizabeth M. Borycki, John A. Bartle-Clar, Mowafa S. Househ, Craig E. Kuziemsky, and Ellen G. Schraa (editors). International Perspectives in Health Informatics. Amsterdam, The Netherlands. IOS Press. Studies in Health Technology and Informatics, volume 164, pages 333-338. ISBN 978-1-60750-708-6. ISSN 0926-9630. © 2011 IOS Press. By permission.
  3. Johanna Viitanen. 2011. Contextual inquiry method for user-centred clinical IT system design. In: Anne Moen, Stig Kjær Andersen, Jos Aarts, and Petter Hurlen (editors). User Centred Networked Health Care. Proceedings of the 23rd International Conference of the European Federation for Medical Informatics (MIE 2011). Oslo, Norway. 28-31 August 2011. Amsterdam, The Netherlands. IOS Press. Studies in Health Technology and Informatics, volume 169, pages 965-969. ISBN 978-1-60750-805-2. ISSN 0926-9630. © 2011 IOS Press. By permission.
  4. Johanna Viitanen, Hannele Hyppönen, Tinja Lääveri, Jukka Vänskä, Jarmo Reponen, and Ilkka Winblad. 2011. National questionnaire study on clinical ICT systems proofs: Physicians suffer from poor usability. International Journal of Medical Informatics, volume 80, number 10, pages 708-725. © 2011 Elsevier Ireland. By permission.
  5. Susanna Martikainen, Johanna Viitanen, Mikko Korpela, and Tinja Lääveri. 2012. Physicians' experiences of participation in healthcare IT development in Finland: Willing but not able. International Journal of Medical Informatics, volume 81, number 2, pages 98-113. © 2011 Elsevier Ireland. By permission.
  6. Johanna Viitanen and Marko Nieminen. 2011. Usability evaluation of digital dictation procedure – An interaction analysis approach. In: Andreas Holzinger and Klaus-Martin Simonic (editors). Information Quality in e-Health. Proceedings of the 7th Conference of the Workgroup Human-Computer Interaction and Usability Engineering of the Austrian Computer Society (USAB 2011). Graz, Austria. 25-26 November 2011. Springer. Lecture Notes in Computer Science, volume 7058, pages 133-149. ISBN 978-3-642-25363-8. ISSN 0302-9743. © 2011 by authors and © 2011 Springer Science+Business Media. By permission.

Keywords: usability, clinical information and communication technology systems, user-centred design, healthcare information system development, clinical work, physician, nurse

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© 2011 Aalto University

Last update 2012-02-14