EHR Usability Test Report of IntelleChartPro, Version 7.0 Report based on ISO/IEC 25062:2006 Common Industry Format for Usability Test Reports

Transcription

1 EHR Usability Test Report of IntelleChartPro, Version 7.0 Report based on ISO/IEC 25062:2006 Common Industry Format for Usability Test Reports IntelleChartPro, Version 7.0 Date of Usability Test: 08/03/ /04/2017 Date of Report: 08/11/2017 Report Prepared By: Nextech Paula Hakanson, Product Owner, Nextech and Tracy Biondo, Product Owner, Nextech and 5550 W. Executive Dr, Suite 350, Tampa, FL Table of Contents Executive Summary... 3 Major findings... 6 Areas for improvement... 6 Introduction... 7 Method... 7 PARTICIPANTS... 7 STUDY DESIGN... 8 TASKS... 9 PROCEDURES... 9 TEST LOCATION TEST ENVIRONMENT TEST FORMS AND TOOLS PARTICIPANT INSTRUCTIONS USABILITY METRICS DATA SCORING Results DATA ANALYSIS AND REPORTING

2 DISCUSSION OF THE FINDINGS EFFECTIVENESS EFFICIENCY SATISFACTION MAJOR FINDINGS AREAS FOR IMPROVEMENT Appendix 4: EXAMPLE MODERATOR S GUIDE EHRUT Usability Test Moderator s Guide CPOE Medications CPOE Labs CPOE Imaging Medication List Medication Allergy List Demographics Problem List Clinical Decision Support Implantable Device List Clinical Information Reconciliation

3 Executive Summary A usability test of IntelleChartPro, Version 7.0 was conducted on August 3, 2017 at Gulf Coast Retina Center in Clearwater, FL and on and August 4, 2017 at Eye Associates of Pinellas in Pinellas Park, FL by Nextech. The purpose of the test was to test and validate the usability of the current user interface, and provide evidence of usability in the EHR Usability Test (EHRUT). During the usability test, ten healthcare professionals matching the target demographic criteria served as participants and used the EHRUT in simulated, but representative tasks. This study collected performance data on 36 tasks conducted on an EHR (see below). A risk scale of 1-5 (1 = least risk and 5 = most risk) was used to account for the patient s safety of performing each of these tasks. The risk rating for each task is list at the end in parenthesis. CPOE (a.1) Record Medication Order (3) CPOE (a.1) Change Medication Order (2) CPOE (a.1) Access Medication Order (1) CPOE (a.2) Record Laboratory Order (5) CPOE (a.2) Change Laboratory Order (4) CPOE (a.2) Access Laboratory Order (1) CPOE (a.3) Record Radiology Order (3) CPOE (a.3) Change Radiology Order (2) CPOE (a.3) Access Radiology Order (1) Demographics (a.5) Record Demographics (1) Demographics (a.5) Change Demographics (1) Demographics (a.5) Access Demographics (1) Problem List (a.6) Record Problem (3) Problem List (a.6) Change Problem (2) Problem List (a.6) Access Active Problems & History List (1) Medication List (a.7) Record Medication List (5) Medication List (a.7) Change Medication List (4) Medication List (a.7) Access Current Medications (1) Medication Allergy List (a.8) Record Allergy List (2) Medication Allergy List (a.8) Change Allergy List (2) Medication Allergy List (a.8) Access Medication Allergies (1) Clinical Decision Support (a.9) Trigger Problem List CDSR (2) Clinical Decision Support (a.9) Trigger Medications CDSR (2 Clinical Decision Support (a.9) Trigger Allergies CDSR (2) Clinical Decision Support (a.9) Trigger Demographics CDSR (1) Clinical Decision Support (a.9) Trigger Lab CDSR (2) Clinical Decision Support (a.9) Trigger Vitals CDSR (2) Clinical Decision Support (a.9) Identify Medication Supporting Reference Material & Info Button (1) Clinical Decision Support (a.9) Configuration CDSR (1) Implantable Device List (a.14) Record UDI (2) Implantable Device List (a.14) View Implantable Device Fields (1) 3

4 Implantable Device List (a.14) Change Status for UDI (2) Implantable Device List (a.14) Access Implantable Device List (1) Clinical Information Reconciliation and Incorporation (b.2) Reconcile Medications (3) Clinical Information Reconciliation and Incorporation (b.2) Reconcile Allergies (2) Clinical Information Reconciliation and Incorporation (b.2) Reconcile Problems (3) During the 120 minute one-on-one usability test, each participant was greeted by the administrator; they were instructed that they could withdraw at any time. Participants had prior experience with the EHR being tested. The administrator introduced the test, and instructed participants to complete a series of tasks (given one at a time) using the EHRUT. During the testing, the administrator timed the test and, along with a data logger, recorded user performance data on paper and electronically. Prior to the test, each participant received training on the areas being tested. This consists of stepping through each MU measure and explaining how each is implemented in IntellechartPro. The administrator did not give the participant assistance in how to complete the task. The following types of data were collected for each participant: Number of tasks successfully completed within the allotted time without assistance Time to complete the tasks Number and types of errors Path deviations Participant s verbalizations Participant s satisfaction ratings of the system All participant data was de-identified no correspondence could be made from the identity of the participant to the data collected. Following the conclusion of the testing, participants were asked to complete a post-test questionnaire and were not compensated by Nextech for their time. Various recommended metrics, in accordance with the examples set forth in the NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records (NISTIR 7741), were used to evaluate the usability of the EHRUT. Following is a summary of the performance and rating data collected on the EHRUT. Table 1.1 Summary of Task Performance N Task Success Path Deviation Task Time Errors Task Ratings Task \ Measure # Mean (Secs) Deviations (Observed / Optimal) Mean (Secs) Deviations (Observed / Optimal) Mean(%) Mean Record Medication Order % % 1.1 4

5 Change Medication Order % % 1.1 Access Medication Order % % 1 Record Lab Order % % 1.7 Change Lab Order % % 1.7 Access Lab Order % % 1.1 Record Diagnostic Order % % 1 Change Diagnostic Order % % 1.1 Access Diagnostic Order % % 1 Record Demographics % % 1.2 Change Demographics % % 1 Access Demographics % % 1 Record Problem % % 1.2 Change Problem % % 1 Access Active Problems & History List % % 1 Record Current Medication % % 1.4 Change Current Medication % % 1 Access Current Medications % % 1 Record Medication Allergy % % 1 Change Medication Allergy % % 1.1 Access Medication Allergies % % 1 Trigger Problem List CDSR % % 1.8 Trigger Medications CDSR % % 1.5 Trigger Allergies CDSR % % 1.6 Trigger Demographics CDSR % % 1 Trigger Lab CDSR % % 1.4 Trigger Vitals CDSR % % 1.4 5

6 Identify Medication Supporting Reference Material & Info Button % % 1.2 Configure CDSR % % 1.2 Record UDI % % 1.8 View Implantable Device Fields % % 1.1 Change Status for UDI % % 1.9 Access Implantable Device List % % 1.1 Reconcile Medications % % 2 Reconcile Allergies % % 1.6 Reconcile Problems % % 1.8 The results from the System Usability Scale scored the subjective satisfaction with the system based on performance with these tasks to be: 36. In addition to the performance data, the following qualitative observations were made: Major findings Participants overall were very pleased with the product and all ten-expressed appreciation for the ease of use to enter the medical problem list history, medication and allergies into the medical record. Some participants commented and expressed a concern over the time it takes to enter systemic medications into the chart due to how the search field works. On some medications, you may only have to enter a couple of letters of the medication and it will appear in the list for you to choose. In some cases, you have to enter several letters to get a result or have to click on a button to generate a list for selection. If the patient has medication this can be time consuming to get this information into the chart. During the testing process, it went smoothly due to only having to enter a couple of medication and they were available right away in the list to choose from. Areas for improvement The Clinical Decision Support alerts were helpful to the users, to be able to trigger specific alerts based on problems, allergies, vitals etc. but it would be helpful to the user to see an indicator of any new alerts that they have not yet viewed for this patient. 6

7 Introduction The EHR tested for this study was IntelleChartPro, Version 7.0. Designed to present medical information to healthcare providers in Ophthalmology Hospitals and Clinics, the EHRUT consists of entering problem list items, medical history, medications, labs, testing and procedures. The usability testing attempted to represent realistic exercises and conditions. The purpose of this study was to test and validate the usability of the current user interface, and provide evidence of usability in the EHR Usability Test (EHRUT). To this end, measures of effectiveness, efficiency and user satisfaction, such as time on task, deviations from optimal path, and errors were captured during the usability testing. Method PARTICIPANTS A total of 10 participants were tested on the EHRUT. Participants in the test were technicians and scribes. Participants were recruited from by Nextech and were not compensated for their time. In addition, participants had no direct connection to the development of or organization producing the EHRUT. Participants were not from the testing or supplier organization. Participants were given the opportunity to have the same orientation and level of training as the actual end users would have received. Recruited participants had a mix of backgrounds and demographic characteristics and were selected as representative of the products user base. The following is a table (Table 3.1) of participants by characteristics, including demographics, professional experience, computing experience and user needs for assistive technology. Participant names were replaced with Participant IDs so that an individual s data cannot be tied back to individual identities. Table 3.1 Participant Demographics Overview Part ID Gender Age Education Occupation /Role Professional Experience Computer Experience Product Experience Assistive Technology Needs Bachelor's ID-A Male 29 Degree Scribe None No No high ID-B Male 29 school degree Tech None No Bachelor's ID-C Female 29 Degree Scribe None No 7

8 4 50- ID-D Female ID-E Male ID-F Male ID-G Male ID-H Male ID-I Female ID-J Female Bachelor's Degree Tech None No Some college Tech and credit, no Surgery degree Coordinator COT No Associate degree Tech None No Bachelor's Degree Tech None No Bachelor's Degree Tech None No Some college credit, no degree Tech None No Associate Scribe None No degree Ten participants (matching the demographics in the section on Participants) were recruited and ten participated in the usability test. No participants failed to show for the study. Participants were scheduled for one, two hour session with five participants in each session. A spreadsheet was used to keep track of the participants testing results, and included each participant s demographic characteristics. STUDY DESIGN Overall, the objective of this test was to uncover areas where the application performed well that is, effectively, efficiently, and with satisfaction and areas where the application failed to meet the needs of the participants. The data from this test may serve as a baseline for future tests with an updated version of the same EHR and/or comparison with other EHRs provided the same tasks are used. In short, this testing serves as both a means to record or benchmark current usability, but also to identify areas where improvements must be made. During the usability test, participants interacted with one EHR, IntelleChartPro. Each participant used the system in the same location, and was provided with the same instructions. The system was evaluated for effectiveness, efficiency and satisfaction as defined by measures collected and analyzed for each participant: Number of tasks successfully completed within the allotted time without assistance Time to complete the tasks Number and types of errors 8

9 Path deviations Participant s verbalizations (comments) Participant s satisfaction ratings of the system Additional information about the various measures can be found in Section 3.9 on Usability Metrics. TASKS A number of tasks were constructed that would be realistic and representative of the kinds of activities a user might do with this EHR, including: Record, Change and Access Medication Order Record, Change and Access Laboratory Order Record, Change and Access Radiology Order Record, Change and Access Demographics Record, Change and Access Problems Record, Change and Access Medication List Record, Change and Access Allergy List Trigger Problem List, Medications, Allergies, Demographics, Lab and Vitals CDSR Identify Medication Supporting Reference Material & Info Button Configuration CDSR Record, View, Change Status and Access Implantable Device Reconcile Medications, Allergies, Reconcile Problems Tasks were selected based on their frequency of use, criticality of function, and those that may be most troublesome for users. Tasks should always be constructed in light of the study objectives. PROCEDURES Upon arrival, participants were greeted; their identity was verified and matched with a name on the participant schedule. Participants were then assigned a participant ID. To ensure that the test ran smoothly, two staff member participated in this test, the usability administrator and the data logger. The usability testing staff conducting the test was experienced usability practitioners with 17 of years of experience, backgrounds in healthcare and information technology and clinical EHR training, implementation and support. The administrator moderated the session including administering instructions and tasks. The administrator also monitored task times, obtained post-task rating data, and took notes on participant comments. A 9

10 second person served as the data logger and took notes on task success, path deviations, number and type of errors, and comments. Participants were instructed to perform the tasks (see specific instructions below: As quickly as possible making as few errors and deviations as possible. Without assistance; the administrator was allowed to give immaterial guidance and clarification on tasks, but not instructions on use. Without using a think aloud technique. For each task, the participants were given a written copy of the task. Task timing began once the administrator finished reading the task instructions. The task time was stopped once the participant indicated they had successfully completed the task. Scoring is discussed below in Section 3.9. Following the session, the administrator thanked each individual for their participation. Participants' demographic information, task success rate, time on task, errors, deviations, verbal responses, and post-test questionnaire were recorded into a spreadsheet. Participants were thanked for their time but not compensated. Participants did not sign a receipt and acknowledgement form because they had not received compensation. TEST LOCATION The test facility included a waiting room and tech room with tables or a workspace, computer for the participant, and moderator s guide and paper for the administrator. Only the participants and administrator were in the test room. To ensure that the environment was comfortable for users, noise levels were kept to a minimum with the ambient temperature within a normal range. All of the safety instructions and evacuation procedures were current, in place, and visible to the participants. TEST ENVIRONMENT The EHRUT would be typically be used in a healthcare office or facility. In this instance, the testing was conducted in a waiting and tech room set up to simulate an office environment. For testing, the computer used was a laptop running Microsoft Windows 10, 64bit. The participants used a generic mouse, keyboard, when interacting with the EHRUT application. The application was set up by Nextech according to the vendor s documentation describing the system setup and preparation. The application itself was running on a cloud based platform using a test database on a 10

11 WAN connection. Technically, the system performance (i.e., response time) was representative to what actual users would experience in a field implementation. Additionally, participants were instructed not to change any of the default system settings (such as control of font size). TEST FORMS AND TOOLS During the usability test, various documents and instruments were used, including: 1. Moderator s Guide 2. Post-test Questionnaire PARTICIPANT INSTRUCTIONS The administrator reads the following instructions aloud to each participant: I want to thank you for taking the time to help us with this study. Your input is very important. Part of our 2015 Edition Certification, we are required to test and validate the usability of our current user interface and provide evidence of usability for our EHR under test. Our session today will last about sixty minutes. During this time, you will use an instance of an EHR. I will ask you to complete a few tasks using this system and answer some questions. You should complete the tasks on your own following the instructions very closely. Please note, we are not testing you we are testing the system. Therefore if you have difficulty completing tasks, all this means is that something needs to be improved in the system. I will be here in case you need specific help, but I am not able to instruct you or provide help in how to use the application. Overall, we are interested in how easy or how difficult the system is to use, what in it would be useful to you, and how we could improve it. All of the information that you provide will be kept confidential and your name will not be associated with your comments at any time. Following the procedural instructions, participants were shown the EHRs. Once this was complete, the administrator gave the following instructions: For each task, I will read the description to you and say Begin. At that point, please perform the task and say Done once you believe you have successfully completed the task. I would like to request that you not talk aloud or verbalize while you are doing the tasks. I will ask your impressions about the task once you are done. Participants were then given 32 tasks to complete. Tasks are listed in the moderator s guide in Appendix 4. USABILITY METRICS According to the NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records, EHRs should support a process that provides a high level of usability for all users. The goal is for users to interact with the system effectively, efficiently, and with an acceptable level of satisfaction. To this 11

12 end, metrics for effectiveness, efficiency and user satisfaction were captured during the usability testing. The goals of the test were to assess: 1. Effectiveness of IntelleChartPro 7.0, by measuring participant success rates and errors 2. Efficiency of IntelleChartPro 7.0, by measuring the average task time and path deviations 3. Satisfaction with IntelleChartPro 7.0, by measuring ease of use ratings DATA SCORING The following table (Table 3.2) details how tasks were scored, errors evaluated, and the time data analyzed. Table 3.2 Data Scoring Metrics Measures Rationale and Scoring Effectiveness: A task was counted as a Success if the participant was able to achieve the correct outcome, without assistance, within the time Task Success allotted on a per task basis. The total number of successes were calculated for each task and then divided by the total number of times that task was attempted. The results are provided as a percentage. Task times were recorded for successes. Observed task times divided by the optimal time for each task is a measure of optimal efficiency. Optimal task performance time, as benchmarked by expert performance under realistic conditions, is recorded when constructing tasks. Target task times used for task times in the Moderator s Guide must be operationally defined by taking multiple measures of optimal performance and multiplying by some factor [e.g., 1.5] that allows some time buffer because the participants are presumably not trained to expert performance. Thus, if expert, optimal performance on a task was [x] seconds then allotted task time performance was [x * 1.5] seconds. This ratio should be aggregated across tasks and reported with mean and variance scores. Effectiveness: Task Failures If the participant abandoned the task, did not reach the correct answer or performed it incorrectly, or reached the end of the allotted time before successful completion, the task was counted as an Failures. No task times were taken for errors. The total number of errors was calculated for each task and then divided by the total number of times that task was attempted. Not all deviations would be counted as errors. 11 This should also be expressed as the mean number of failed tasks per participant. On a qualitative level, an enumeration of errors and error types should be collected. 12

13 Efficiency: Task Deviations The participant s path (i.e., steps) through the application was recorded. Deviations occur if the participant, for example, went to a wrong screen, clicked on an incorrect menu item, followed an incorrect link, or interacted incorrectly with an on-screen control. This path was compared to the optimal path. The number of steps in the observed path is divided by the number of optimal steps to provide a ratio of path deviation. Results DATA ANALYSIS AND REPORTING The results of the usability test were calculated according to the methods specified in the Usability Metrics section above. There were no participants who failed to follow session and task instructions. The usability testing results for the EHRUT are detailed below (see Table 4.1). The results should be seen in light of the objectives and goals outlined in Section 3.2 Study Design. The data should yield actionable results that, if corrected, yield material, positive impact on user performance. Table 4.1 Results Summary By Task Task \ Measure N # Task Succes s Path Deviation Task Time Errors Mean (Secs) Deviations (Observed / Optimal) Mean (Secs) Task Ratin gs Deviatio ns (Observe d / Optimal) Mean(%) Mean % % % % % % % % % % % % % % % % % % 1 13

14 % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % 2 14

15 % % % % 1.8 DISCUSSION OF THE FINDINGS Participants rated 12 of the 36 tasks as Very Easy. Below are details of all tasks which were not completed, or contained path deviations, or technical issues. Task 11, change current medication, was easily completed by all participants. The participants are used to entering different information that required of the test, so some of them clicked into some fields not needing to be updated. Task 16, record demographics, was easily completed by all participants; however one participant entered the home phone number in the mobile phone field. All the participants do not work in the demographics section often, and never add or update any of the demographics, so they were a little slower on this task. Task 19, record problem, was easily completed by all participants, however a couple participants used the search box instead of selecting the problem from the list, which was near the top of the list. EFFECTIVENESS The results by task show 100% successful completion of the tasks by all participants. 21 of the 36 tasks were successfully completed by all users following the intended (optimal) path. This is largely due to the participants being used to entering data in a different sequence while seeing patients. In the remaining tasks where sub-optimal paths were utilized, correct results were still obtained. Sub-optimal paths did increase the standard deviations and also resulted in users exceeding optimal time. EFFICIENCY None of the tasks were completed within the optimal time because each participant has their own flow when using the chart, which is not always the optimal path. This resulted in 27 of the 36 tasks being done sooner than optimal and 9 being dong longer than the optimal. 15

16 It can be noted that while user ID-G has 4 years of experience with the EHR, the user was slow to perform most tasks and clicked around more than necessary. The user was a little nervous doing the tasks while being timed and observed. The other participants were not bothered by being observed. SATISFACTION Users uniformly found the system to be very easy to easy to use (1 and 1.1 ranking). In many cases, even when the users took a sub-optimal path to achieve the results, they viewed the software as easy to use. MAJOR FINDINGS Participants were overall very pleased with the product. Participants stated the application seemed to have a good flow from one area to the next with easy access icons and was relatively user-friendly, seemed easy to learn and easy to use. AREAS FOR IMPROVEMENT IntelleChartPro was recently redesigned to be more user friendly and have a smoother, more efficient workflow for the users. 16

17 APPENDIX Appendix 4: EXAMPLE MODERATOR S GUIDE EHRUT Usability Test Moderator s Guide I want to thank you for taking the time to help us with this study. Your input is very important. Part of our 2015 Edition Certification, we are required to test and validate the usability of our current user interface and provide evidence of usability for our EHR under test. Our session today will last about sixty minutes. During this time, you will use an instance of an EHR. I will ask you to complete a few tasks using this system and answer some questions. You should complete the tasks on your own following the instructions very closely. Please note, we are not testing you we are testing the system. Therefore if you have difficulty completing tasks, all this means is that something needs to be improved in the system. I will be here in case you need specific help, but I am not able to instruct you or provide help in how to use the application. Overall, we are interested in how easy or how difficult the system is to use, what in it would be useful to you, and how we could improve it. All of the information that you provide will be kept confidential and your name will not be associated with your comments at any time. For each task, I will read the description to you and say Begin. At that point, please perform the task and say Done once you believe you have successfully completed the task. I would like to request that you not talk aloud or verbalize while you are doing the tasks. I will ask your impressions about the task once you are done. CPOE Medications Task 1 Record Medication Order During the patient visit, the provider would like you to order (just enter, do not send to a pharmacy) the following medication: (Click on Ocular Meds field, search for med, select med, add dose, dose unit, schedule and administer, select eye location and then close control) Drug: Zymaxid 0.5% Dose: 1 Route: gtt Frequency: QID Administer: OD Order this medication now. Optimal Path: # steps: 4; time: 7.75 Task 2 Change Medication Order 17

18 The provider would like you to change the order for Zymaxid from QID to TID. (click on data bubble, click on schedule dropdown, select appropriate schedule and then close control) Current Frequency: QID Change Frequency To: TID Make the change to this frequency now. Optimal Path: # steps: 4; time: 5:42 Task 3 Access Medication Order The provider would like you to access the order for Zymaxid (which means view details). (click on data bubble) Locate this medication order and review the details. Optimal Path: # steps 1; time:.53 CPOE Labs Task 1 Record Lab Order The provider would like you to order the following laboratory order: (click on Study area, click on Study dropdown, select study, select labs then close the control) Order: GCA Studies Test To Be Ordered: CBC with Differential Order this laboratory order now. Optimal Path: # steps 5; time:7.01 Task 2 Change Lab Order The provider would like you to change the laboratory order from CBC with Differential to CRP. (click on study bubble, de-select lab, select new lab and then close control) Current Laboratory Order: CBC with Differential Change Laboratory Order To: CRP Make the change to this laboratory order now. Optimal Path: # steps 4; time: 4:06 Task 3 Access Lab Order The provider would like you to access the laboratory order for C-Reactive Protein (which means view details). Locate this laboratory order and review the details. (click on study bubble) Optimal Path: # steps1; time:.74 CPOE Imaging Task 1 Record Diagnostic Order The provider would like you to order the following diagnostic order: (click on plus sign to add order, select order, select eye location and then close control) Order: Diagnostic 18

19 Test To Be Ordered: Fundus Order this radiology order now. Optimal Path: # steps 4; time: 3:92 Task 2 Change Diagnostic Order The provider would like you to change the diagnostic order from Fundus to Fundus & Fluorescein Angiography. (click on plus sign to add order, select order, select eye location and then close control) Current Radiology Order: Fundus Change Radiology Order To: Fundus & Fluorescein Angiography Make the change to this diagnostic order now. Optimal Path: # steps 4; time: 4:04 Task 3 Access Diagnostic Order The provider would like you to access the diagnostic order for Fundus & Fluorescein Angiography (which means view details). (click on order bubble) Locate this diagnostic order and review the details. Optimal Path: # steps 1; time:.48 Medication List Task 1 Record Current Medication The provider would like you to record a list of current medications the patient takes at home. Enter the following medications on the patient s current medication list: (Click on Systemic meds area, search for med, select med, select dosage, dose unit and administer, search for next med, select med, select dosage, dose unit and administer and then close control) Drug: Simvastatin Dose: 10 mg Quantity: 1 tablet Route: by mouth (PO) Drug: Dose: Quantity: Route: Lasix 40 mg 1 tablet by mouth (PO) Enter the current medications now. Optimal Path: # steps 13; time: Task 2 Change Current Medication The provider would like you to change the quantity of Lasix from 1 tablet to 2 tablets. (select med bubble that you want to change, select new tablet quantity and then close control) 19

20 Drug: Lasix Current Quantity: 1 tablet Change Quantity To: 2 tablets Make the change to the current medication quantity now. Optimal Path: # steps 3; time: 3:69 Task 3 Access Current Medications The provider would like you to access the patient s current medication list (which means view details). Access the patient s current medication list now. (select medication bubble) Optimal Path: # steps 1;time:.82 Medication Allergy List Task 1 Record Medication Allergy The provider would like you to record/ create a list of allergies the patient has. Enter the following allergies to the patient s allergy list. (click on allergy section, click on Common drug allergy, select allergy, select severity, click on food allergy, select allergy, select severity and then close control) Allergy: Codeine Severity: Mild Allergy: Severity: Peanuts Severe Enter the allergies now. Optimal Path: # steps 8; time: 10:29 Task 2 Change Medication Allergy The provider would like you to change an allergy the patient has from severe Peanuts allergy to moderate. Enter the following changes to the patient s allergy list: (click on food allergy bubble, select new severity then close control) Allergy: Peanuts Current Severity: Severe Change Severity To: Moderate Update the allergy severity now. Optimal Path: # steps 3; time: 4:38 Task 3 Access Medication Allergies The provider would like you to access the patient s allergy list (which means view details). Access the patient s allergy list now. (Click on allergy bubble) Optimal Path: # steps 1; time: 1:32 20

21 Demographics Task 1 Record Demographics The patient does not have all their demographic fields completed. Fill in the following details for the patient: (type in mobile phone number, select occupation field and type occupation, then save) Mobile Phone: Occupation: Teacher Record these demographic fields for the patient now. Optimal Path: # steps 3; time: 12:55 Task 2 Change Demographics The patient has moved since the last time they were in the office. Update their address to the following: (change address to new address and the save) Current Address: 123 Main Street, Tampa, FL Update Address To: 456 Easy Street, Tampa, FL Update these demographic fields for the patient now. Optimal Path: # steps 2; time: 6:76 Task 3 Access Demographics The provider would like you to access the patient s race and language (which means view details). Access the patient s race and language fields now. (click on demographics) Optimal Path: # steps 1; time:.53 Problem List Task 1 Record Problem The provider wants you to add an EMR problem to the patient s record. Add the following problem to the patient s EMR: (click on Problem list area, select problem, select the severity of problem, select eye location and then close control) Problem Description: Neovascular AMD with Inactive CNV Eye Location: OS ICD10 Code: H Record this problem for the patient now. Optimal Path: # steps 5; time: 4:89 Task 2 Change Problem The provider wants you to change the EMR problem from Neovascular AMD with Inactive CNV to Neovascular AMD with Active CNV. Enter the following EMR problem changes now: (click on problem bubble, click on new severity problem and then close control) Current Problem List Item: Neovascular AMD with Inactive CNV OS Change Problem List Item To: Neovascular AMD with Active CNV OS New ICD10 Code: H

22 Change this problem for the patient now. Optimal Path: # steps 3; time: 3:13 Task 3 Access Active Problems & History List The provider would like you to access the patient s EMR problem list (which means view details). Access the patient s EMR problem list now. (click on problem bubble) Optimal Path: # steps 1; time:.53 Clinical Decision Support Task 1 Trigger Problem List CDSR During the patient s visit, the provider would like you to add a problem to the patients EMR problem list. (Purpose: to trigger a problem list intervention alert). Add the following problem to the patient s EMR to see the alert: (click on problem list, search for problem, select problem, select a descriptive problem, select eye location, close control, click on alert then close alert) Problem Description: Central Serous Chorioretinopathy (CSR) Eye Location: OD ICD10 Code: H Add this problem now to see the warning. Optimal Path: # steps 8; time: 11:16 Task 2 Review Medications CDSR The provider wants to prescribe Bromfenac 0.09% for the patient. (Purpose: to trigger a medication list intervention alert). (click on medication area, search med, select med, select eye location, close control, click on alert, close alert) Enter Medication in Ocular Meds: Bromfenac 0.09% 1 gtt qday OD Now see the clinical decision support alert for Bromfenac. Optimal Path: # steps 7; time: 16:35 Task 3 Review Allergies CDSR The provider is getting ready to see a patient. (Purpose: to see triggered allergy list intervention alerts). (click on allergy area, click on Common drug allergy, select allergy, close control, click on alert, close alert) Add Allergy to Patient: Penicillin Now see clinical decision support alert for Penicillin allergy. Optimal Path: # steps 6; time: 17:90 Task 4 Review Demographics CDSR A patient s age is greater than 65 years old. (Purpose: to see triggered a demographic alert). Now access the alert for Demographics( click on alert, close alert) 22

23 Optimal Path: # steps 2; time: 1:56 Task 5 Review Lab (Studies) CDSR During the visit, a lab result returned abnormally high results for the C-Reactive Protein. (Purpose: to see triggered lab result intervention alert). Add the following lab order: (click on lab order, select lab, close control, click on alert, close alert) Study: GCA Studies Lab: C-Reactive Protein Now to see clinical decision support alerts for C-Reactive Protein. Optimal Path: # steps 5; time: 6:00 Task 6 Trigger Vitals CDSR During a routine blood pressure check, record the patient s vitals for your blood pressure reading. (Purpose: to trigger vital signs intervention alert). Record the following blood pressure reading: (click on vitals area, enter systolic, enter diastolic, close control, click on alert, close alert) Systolic: 90 Diastolic: 120 Record this vital entry now to see the warning. Optimal Path: # steps 6; time: 8:54 Task 7 Identify Medication Supporting Reference Material & Info Button The patient is about to have a procedure performed. You notice from the previous blood pressure check the alert said they have an elevated blood pressure. You would like to view the references for this vital signs alert. (Purpose: to open and view an interventions alert s reference material). (click on alert, click on vitals alert, close alert) Open patient s chart now to see clinical decision support alert reference information. Optimal Path: # steps 3; time: 3:13 Task 8 Configure CDSR (test administrator will switch to a user without the permissions to access the alerts) As a front desk user, verify you do not have permission to view the support rules (CDS Interventions from Activities). (Purpose: to verify not all users can access the alerts/interventions). (View that there is not alert to access) Open patient s chart now to attempt to view clinical decision support alert and verify you cannot. Optimal Path: # steps 1; time: 2:11 Implantable Device List Task 1 Record UDI 23

24 The provider just implanted a device for the patient. The provider would like you to add the UDI to the patient s device list. The UDI has been pasted into the patient s Encounter Notes for you to copy. Add the following UDI: UDI: =/ =,000025=A =>014032=}013032&, XYZ 123 Record this UDI for the patient now. (click on Add, enter UDI number, click on Get Device Information, click on save) Optimal Path: # steps 4; time: 7:87 Task 2 View Implantable Device Fields Now that the UDI has been added for the patient. View the details for the UDI: UDI: =/ =,000025=A =>014032=}013032&, XYZ 123 Brand Name: RestoreULTRA View the UDI details now. (click on Info, click ok) Optimal Path: # steps 2; time: 1:65 Task 3 Change Status for UDI The RestoreUltra neurostimulator has been removed. The provider needs you to change the status of the UDI from Active to Inactive. Please change the status for the following UDI: (click on Edit, uncheck Active Status, click on calendar, enter Inactive date, click save) Change the status to inactive for the patient s UDI now by entering an inactive date. Optimal Path: # steps 5; time: 5:76 Task 4 Access Implantable Device List The provider wants you to access the patient s list of implantable devices (which means view details). Access the patient s list of implantable devices now. (click on info) Optimal Path: # steps 1; time:.53 Clinical Information Reconciliation Task 1 Reconcile Medications The patient had a CCDA sent from their primary care physician. It was received and uploaded. It will be viewable in the patient s chart under settings. Reconcile the patient s systemic medication list with the outside source from the CCDA. (click on view CCDA, click on dropdown for list of dates, select date of CCDA, select systemic meds tab, select med, select other med, click ok, select ok to acknowledge you want to add to patients record) Add: Aranesp 0.5mg MG/ML Add: Ceftriaxone 100gm per 1000ml Injectable Solution 24

25 Reconcile the patient s medications with the outside source from the CCDA now. Optimal Path: # steps 8; time: 13:78 Task 2 Reconcile Allergies The patient had a CCDA sent from their primary care physician. It was received and uploaded. It will be viewable in the patient s chart under settings. Reconcile the patient s allergy list with the outside source from the CCDA. (click on view CCDA, click on dropdown for list of dates, select date of CCDA, select allergy tab, select allergy, click ok, select ok to acknowledge you want to add to patients record) Add: Ampicillin Reconcile the patient s allergies with the outside source from the CCDA now. Optimal Path: # steps 7; time: 9:39 Task 3 Reconcile Problems The patient had a CCDA sent from their primary care physician. It was received and uploaded. It will be viewable in the patient s chart under settings. Reconcile the patient s problem list with the outside source from the CCDA. (click on view CCDA, click on dropdown for list of dates, select date of CCDA, select problems tab, select problem, click ok, select ok to acknowledge you want to add to patients record, click on Clinical Information Reconciled) Add: Essential hypertension Reconcile the patient s problems with the outside source from the CCDA now. Optimal Path: # steps 8; time: 9:47 25