Importance of testing for usability when selecting and implementing an electronic health or medical record system.

PURPOSE: An oncology electronic health record (EHR) was implemented without prior usability testing. Before expanding the system to new clinics, this study was initiated to examine the role of usability testing in the evaluation of an EHR product and whether novice users could identify issues with usability that resonated with more experienced users of the system. In addition, our study evaluated whether usability issues with an already implemented system affect efficiency and satisfaction of users. METHODS: A general usability guide was developed by a group of five informaticists. Using this guide, four novice users evaluated an EHR product and identified issues. A panel of five experts reviewed the identified issues to determine agreement with and applicability to the already implemented system. A survey of 42 experienced users of the previously implemented EHR was also performed to assess efficiency and general satisfaction. RESULTS: The novice users identified 110 usability issues. Our expert panel agreed with 90% of the issues and recommendations for correction identified by the novice users. Our survey had a 54% response rate. The majority of the experienced users of the previously implemented system, which did not benefit from upfront usability testing, had a high degree of dissatisfaction with efficiency and general functionality but higher overall satisfaction than expected. CONCLUSION: In addition to reviewing features and content of an EHR system, usability testing could improve the chances that the EHR design is integrated with existing workflow and business processes in a clear and efficient way.

Open source tools in support of a multi-center prospective biomarker study in prostate cancer.

The open source software tools developed at UCLA are the informatics infrastructure supporting translational research efforts of the 11 National Cancer Institutes Prostate SPORE sites. The Codebook is a caBIG compliant application that manages PHI (e.g. names, medical record numbers, etc.) separately from research data. Research data are collected using a flexible clinical trials management suite called pTracker. Our poster will present how these two applications are implemented and function in this prospective multi-center study.

The Central Codebook (CCB) at the David Geffen School of Medicine at UCLA.

Separating personal health information (PHI) from research data is a critical issue. In our work the Central CodeBook (CCB) functions as an 'honest broker' by mapping between internally meaningful, subject codes (IDs) and sensitive external identifiers like medical record numbers. The CCB is a web service enabled database-backed web application that brokers communications with our evolving EMR via the Clinical Information Network Exchange (CNEX).

Using fresh tissue dissection to teach human anatomy in the clinical years.

PURPOSE: Gross anatomy is taught in medical school with textbooks, cadaver dissection, plastic models, and multimedia illustration, but all lack the reality of color and texture that is possible with fresh tissue dissection. The authors studied the use of fresh tissue dissection of the thorax and abdomen of the rat to teach human anatomy. METHOD: In a half-day exercise, 52 fourth-year medical students paired off and completed an exercise to dissect in less than three hours the thorax and abdomen of a euthanized rat. Observation of organs was augmented by active manipulation such as passing a tube down the esophagus, cannulating the trachea and inflating the lungs, injecting dye in the kidney to trace the ureter and bladder, and pulling the testis through the inguinal canal. Comparison of the rat and human was emphasized to enhance the education. The exercise ended with practice suturing fresh tissue. RESULTS: Students rated the exercise to teach anatomy as 4.9 positive on a 5.0 (high) scale. The significant positive structures (p <.05) for texture were heart, liver, lungs and trachea; for color they were lungs and spleen; for location and size they were adrenal gland and urinary bladder; and for function they were adrenal gland and esophagus. CONCLUSION: Fresh tissue dissection of the thorax and abdomen of the rat is a valuable tool for human anatomy education. The dissonances in human and rat anatomy enhance abstraction and transfer of knowledge. Active manipulation of organs promotes retention of knowledge, and suturing provides a "clinical" context. Fresh tissue dissection is an efficient innovative method to provide a global review of anatomy of the thorax and abdomen during the busy clinical years of medical education.