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Journal Description

JMIR Human Factors (JHF, ISSN 2292-9495; Editor-in-Chief: Prof. Andre Kushniruk) is a multidisciplinary journal with contributions from design experts, medical researchers, engineers, and social scientists.

JMIR Human Factors focuses on understanding how the behaviour and thinking of humans can influence and shape the design of health care interventions and technologies, and how the design can be evaluated and improved to make health care interventions and technologies usable, safe, and effective. This includes usability studies and heuristic evaluations, studies concerning ergonomics and error prevention, design studies for medical devices and healthcare systems/workflows, enhancing teamwork through Human Factors based teamwork training, measuring non-technical skills in staff like leadership, communication, situational awareness and teamwork, and healthcare policies and procedures to reduce errors and increase safety.
JHF aspires to lead health care towards a culture of "usability by design", as well as to a culture of testing, error-prevention and safety, by promoting and publishing reports rigorously evaluating the usability and human factors aspects in health care, as well as encouraging the development and debate on new methods in this emerging field. 

All articles are professionally copyedited and typeset, ready for indexing in PubMed/PubMed Central. Possible contributions include usability studies and heuristic evaluations, studies concerning ergonomics and error prevention, design studies for medical devices and healthcare systems/workflows, enhancing teamwork through Human Factors based teamwork training, measuring non-technical skills in staff like leadership, communication, situational awareness and teamwork, and healthcare policies and procedures to reduce errors and increase safety. Reviews, viewpoint papers and tutorials are as welcome as original research.

Recent Articles:

  • Source: Pixabay; Copyright: Pexels; URL:; License: Licensed by JMIR.

    Factors Influencing Motivation and Engagement in Mobile Health Among Patients With Sickle Cell Disease in Low-Prevalence, High-Income Countries: Qualitative...


    Background: Sickle cell disease (SCD) is a hematological genetic disease affecting over 25 million people worldwide. The main clinical manifestations of SCD, hemolytic anemia and vaso-occlusion, lead to chronic pain and organ damages. With recent advances in childhood care, high-income countries have seen SCD drift from a disease of early childhood mortality to a neglected chronic disease of adulthood. In particular, coordinated, preventive, and comprehensive care for adults with SCD is largely underresourced. Consequently, patients are left to self-manage. Mobile health (mHealth) apps for chronic disease self-management are now flooding app stores. However, evidence remains unclear about their effectiveness, and the literature indicates low user engagement and poor adoption rates. Finally, few apps have been developed for people with SCD and none encompasses their numerous and complex self-care management needs. Objective: This study aimed to identify factors that may influence the long-term engagement and user adoption of mHealth among the particularly isolated community of adult patients with SCD living in low-prevalence, high-income countries. Methods: Semistructured interviews were conducted. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Analysis was informed by the Braun and Clarke framework and mapped to the COM-B model (capability, opportunity, motivation, and behavior). Results were classified into high-level functional requirements (FRs) and nonfunctional requirements (NFRs) to guide the development of future mHealth interventions. Results: Overall, 6 males and 4 females were interviewed (aged between 21 and 55 years). Thirty FRs and 31 NFRs were extracted from the analysis. Most participants (8/10) were concerned about increasing their physical capabilities being able to stop pain symptoms quickly. Regarding the psychological capability aspects, all interviewees desired to receive trustworthy feedback on their self-care management practices. About their physical opportunities, most (7/10) expressed a strong desire to receive alerts when they would reach their own physiological limitations (ie, during physical activity). Concerning social opportunity, most (9/10) reported wanting to learn about the self-care practices of other patients. Relating to motivational aspects, many interviewees (6/10) stressed their need to learn how to avoid the symptoms and live as normal a life as possible. Finally, NFRs included inconspicuousness and customizability of user experience, automatic data collection, data shareability, and data privacy. Conclusions: Our findings suggest that motivation and engagement with mHealth technologies among the studied population could be increased by providing features that clearly benefit them. Self-management support and self-care decision aid are patients’ major demands. As the complexity of SCD self-management requires a high cognitive load, pervasive health technologies such as wearable sensors, implantable devices, or inconspicuous conversational user interfaces should be explored to ease it. Some of the required technologies already exist but must be integrated, bundled, adapted, or improved to meet the specific needs of people with SCD.

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    Influencing Pain Inferences Using Random Numerical Anchoring: Randomized Controlled Trial


    Background: Numerical anchoring occurs when exposure to a numeric quantity influences a person’s subsequent judgment involving other quantities. This could be applicable to the evaluation of pain, where exposure to an unrelated number before the evaluation of pain could influence pain ratings. Objective: This study aimed to determine whether exposure to a random numeric anchor influences subsequent pain intensity ratings of a hypothetical patient. Methods: In this study, 385 participants read a vignette describing a patient with chronic pain before being randomly assigned to one of four groups. Groups 1 and 2 spun an 11-wedge number wheel (0-10), which was, unbeknown to the participants, programmed to stop on a high number (8) or a low number (2), respectively. Group 3 spun a similar letter wheel (A-K), which was programmed to stop on either the letter C or I (control 1). Group 4 did not spin a wheel (control 2). Participants were then asked to rate the patient’s pain intensity using a 0 to 10 numeric rating scale. Results: The high-number group rated the patient’s pain (median 8, IQR 2) significantly higher than the letter wheel control (median 7, IQR 2; P=.02) and the low-number group (median 6, IQR 2; P<.001). The low-number group rated the pain significantly lower than controls 1 and 2 (median 7, IQR 2; both P=.045). Conclusions: Pain ratings were influenced by prior exposure to a random number with no relevant information about the patient’s pain, indicating anchoring had occurred. However, contrary to the traditional definition of anchoring where anchoring occurs even when participants are unaware of the anchor’s influence, in this study, the anchoring effect was seen only in participants who believed that the anchor had influenced them. This suggests that anchoring effects could potentially occur among health care providers tasked with evaluating a patient’s pain and should be evaluated further.

  • Elderly people using the ColorApp on a mobile phone. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Effectiveness of the ColorApp Mobile App for Health Education and Promotion for Colorectal Cancer: Quasi-Experimental Study


    Background: Lack of knowledge and poor attitude are barriers to colorectal cancer screening participation. Printed material, such as pamphlets and posters, have been the main approach in health education on disease prevention in Malaysia. Current information technology advancements have led to an increasing trend of the public reading from websites and mobile apps using their mobile phones. Thus, health information dissemination should also be diverted to websites and mobile apps. Increasing knowledge and awareness could increase screening participation and prevent late detection of diseases such as colorectal cancer. Objective: This study aimed to assess the effectiveness of the ColorApp mobile app in improving the knowledge and attitude on colorectal cancer among users aged 50 years and older, who are the population at risk for the disease in Kedah. Methods: A quasi-experimental study was conducted with 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment programs in Kota Setar district were in the intervention group; Kuala Muda district was the control group. Participants were given a self-administered validated questionnaire on knowledge and attitudes toward colorectal cancer. A mobile app, ColorApp (Colorectal Cancer Application), was developed as a new educational tool for colorectal cancer prevention. The intervention group used the app for two weeks. The same questionnaire was redistributed to both groups after two weeks. The mean percentage scores for knowledge and attitude between groups were compared using repeated measure ANCOVA. Results: There was no significant difference in age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in the intervention group compared with the control group and was controlled for during analysis. The intervention group showed a significantly higher mean knowledge score compared with the control group with regards to time (Huynh-Feldt: F1,95=19.81, P<.001). However, there was no significant difference in mean attitude scores between the intervention and control groups with regards to time (F1,95=0.36, P=.55). Conclusions: The ColorApp mobile app may be an adjunct approach in educating the public on colorectal cancer.

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    A Chatbot-Based Coaching Intervention for Adolescents to Promote Life Skills: Pilot Study


    Background: Adolescence is a challenging period, where youth face rapid changes as well as increasing socioemotional demands and threats, such as bullying and cyberbullying. Adolescent mental health and well-being can be best supported by providing effective coaching on life skills, such as coping strategies and protective factors. Interventions that take advantage of online coaching by means of chatbots, deployed on Web or mobile technology, may be a novel and more appealing way to support positive mental health for adolescents. Objective: In this pilot study, we co-designed and conducted a formative evaluation of an online, life skills coaching, chatbot intervention, inspired by the positive technology approach, to promote mental well-being in adolescence. Methods: We co-designed the first life skills coaching session of the CRI (for girls) and CRIS (for boys) chatbot with 20 secondary school students in a participatory design workshop. We then conducted a formative evaluation of the entire intervention—eight sessions—with a convenience sample of 21 adolescents of both genders (mean age 14.52 years). Participants engaged with the chatbot sessions over 4 weeks and filled in an anonymous user experience questionnaire at the end of each session; responses were based on a 5-point Likert scale. Results: A majority of the adolescents found the intervention useful (16/21, 76%), easy to use (19/21, 90%), and innovative (17/21, 81%). Most of the participants (15/21, 71%) liked, in particular, the video cartoons provided by the chatbot in the coaching sessions. They also thought that a session should last only 5-10 minutes (14/21, 66%) and said they would recommend the intervention to a friend (20/21, 95%). Conclusions: We have presented a novel and scalable self-help intervention to deliver life skills coaching to adolescents online that is appealing to this population. This intervention can support the promotion of coping skills and mental well-being among youth.

  • Source: Needpix; Copyright: StockSnap; URL:; License: Public Domain (CC0).

    Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized...


    Background: Recent evidence in mobile health has demonstrated that, in some cases, apps are an effective way to improve health care delivery. Health care interventions delivered via mobile technology have demonstrated both practicality and affordability. Lately, cognitive behavioral therapy (CBT) interventions delivered over the internet have also shown a meaningful impact on patients with anxiety and depression. Objective: Given the growing proliferation of smartphones and the trust in apps to support improved health behaviors and outcomes, we were interested in comparing a mobile app with Web-based methods for the delivery of CBT. This study aimed to compare the usability of a CBT mobile app called MoodTrainer with an evidence-based website called MoodGYM. Methods: We used convenience sampling to recruit 30 students from a large Midwestern university and randomly assigned them to either the MoodGYM or MoodTrainer user group. The trial period ran for 2 weeks, after which the students completed a self-assessment survey based on Nielsen heuristics. Statistical analysis was performed to compare the survey results from the 2 groups. We also compared the number of modules attempted or completed and the time spent on CBT strategies. Results: The results indicate that the MoodTrainer app received a higher usability score when compared with MoodGYM. Overall, 87% (13/15) of the participants felt that it was easy to navigate through the MoodTrainer app compared with 80% (12/15) of the MoodGYM participants. All MoodTrainer participants agreed that the app was easy to use and did not require any external assistance, whereas only 67% (10/15) had the same opinion for MoodGYM. Furthermore, 67% (10/15) of the MoodTrainer participants found that the navigation controls were easy to locate compared with 80% (12/15) of the MoodGYM participants. MoodTrainer users, on average, completed 2.5 modules compared with 1 module completed by MoodGYM users. Conclusions: As among the first studies to directly compare the usability of a mobile app–based CBT with smartphone-specific features against a Web-based CBT, there is an opportunity for app-based CBT as, at least in our limited trial, it was more usable and engaging. The study was limited to evaluate usability only and not the clinical effectiveness of the app.

  • Source: Pexels; Copyright: Lukas; URL:; License: Licensed by JMIR.

    Exploring How Professionals Within Agile Health Care Informatics Perceive Visualizations of Log File Analyses: Observational Study Followed by a Focus Group...


    Background: An increasing number of software companies work according to the agile software development method, which is difficult to integrate with user-centered design (UCD) practices. Log file analysis may provide opportunities for integrating UCD practices in the agile process. However, research within health care information technology mostly has a theoretical approach and is often focused on the researcher’s interpretation of log file analyses. Objective: We aimed to propose a systematic approach to log file analysis in this study and present this to developers to explore how they react and interpret this approach in the context of a real-world health care information system, in an attempt to answer the following question: How may log file analyses contribute to increasing the match between the health care system and its users, within the agile development method, according to agile team members? Methods: This study comprised 2 phases to answer the research question. In the first phase, log files were collected from a health care information system and subsequently analyzed (summarizing sequential patterns, heat mapping, and clustering). In the second phase, the results of these analyses are presented to agile professionals during a focus group interview. The interpretations of the agile professionals are analyzed by open axial coding. Results: Log file data of 17,924 user sessions and, in total, 176,678 activities were collected. We found that the Patient Timeline is mainly visited, with 23,707 (23,707/176,678; 13.42%) visits in total. The main unique user session occurred in 5.99% (1074/17,924) of all user sessions, and this comprised Insert Measurement Values for Patient and Patient Timeline, followed by the page Patient Settings and, finally, Patient Treatment Plan. In the heat map, we found that users often navigated to the pages Insert Measurement Values and Load Messages Collaborate. Finally, in the cluster analysis, we found 5 clusters, namely, the Information-seeking cluster, the Collaborative cluster, the Mixed cluster, the Administrative cluster, and the Patient-oriented cluster. We found that the interpretations of these results by agile professionals are related to stating hypotheses (n=34), comparing paths (n=31), benchmarking (n=22), and prioritizing (n=17). Conclusions: We found that analyzing log files provides agile professionals valuable insights into users’ behavior. Therefore, we argue that log file analyses should be used within agile development to inform professionals about users’ behavior. In this way, further UCD research can be informed by these results, making the methods less labor intensive. Moreover, we argue that these translations to an approach for further UCD research will be carried out by UCD specialists, as they are able to infer which goals the user had when going through these paths when looking at the log data.

  • Source:; Copyright: cottonbro; URL:; License: Licensed by JMIR.

    Using Patient Portals to Improve Patient Outcomes: Systematic Review


    Background: With the advent of electronic health record (EHR) systems, there is increasing attention on the EHR system with regard to its use in facilitating patients to play active roles in their care via secure patient portals. However, there is no systematic review to comprehensively address patient portal interventions and patient outcomes. Objective: This study aimed to synthesize evidence with regard to the characteristics and psychobehavioral and clinical outcomes of patient portal interventions. Methods: In November 2018, we conducted searches in 3 electronic databases, including PubMed, EMBASE, and Cumulative Index to Nursing and Allied Health Literature, and a total of 24 articles met the eligibility criteria. Results: All but 3 studies were conducted in the United States. The types of study designs varied, and samples predominantly involved non-Hispanic white and highly educated patients with sizes ranging from 50 to 22,703. Most of the portal interventions used tailored alerts or educational resources tailored to the patient’s condition. Patient portal interventions lead to improvements in a wide range of psychobehavioral outcomes, such as health knowledge, self-efficacy, decision making, medication adherence, and preventive service use. Effects of patient portal interventions on clinical outcomes including blood pressure, glucose, cholesterol, and weight loss were mixed. Conclusions: Patient portal interventions were overall effective in improving a few psychological outcomes, medication adherence, and preventive service use. There was insufficient evidence to support the use of patient portals to improve clinical outcomes. Understanding the role of patient portals as an effective intervention strategy is an essential step to encourage patients to be actively engaged in their health care.

  • VitalPatch. Source: VitalPatch; Copyright: VitalPatch; URL:; License: Licensed by the authors.

    Remote Patient Monitoring in Adults Receiving Transfusion or Infusion for Hematological Disorders Using the VitalPatch and accelerateIQ Monitoring System:...


    Background: Frequent vital sign monitoring during and after transfusion of blood products and certain chemotherapies or immunotherapies is critical for detecting infusion reactions and treatment management in patients. Currently, patients return home with instructions to contact the clinic if they feel unwell. Continuous monitoring of vital signs for hematological patients treated with immunotherapy or chemotherapy or receiving blood transfusions using wearable electronic biosensors during and post treatment may improve the safety of these treatments and make remote data collection in an outpatient care setting possible. Objective: This study aimed to evaluate patient experiences with the VitalPatch wearable sensor (VitalConnect) and to evaluate the usability of data generated by the physIQ accelerateIQ monitoring system for the investigator and nurse. Methods: A total of 12 patients with hematological disorders receiving red blood cell transfusions, an intravenous (IV) proteasome inhibitor, or an IV immunotherapy agent were included in the study and wore the VitalPatch for 12 days. Patients completed questionnaires focusing on wearability and nurses completed questionnaires focusing on the usability of the VitalPatch. Results: A total of 12 patients were enrolled over 9 months, with 4 receiving red blood cell transfusions, 4 receiving IV proteasome inhibitors, and 4 receiving IV immunotherapy. These patients were treated for diseases such as multiple myeloma, myelodysplastic syndrome, and non-Hodgkin lymphoma. Of these patients, 83% (10/12) were aged 60 years and older. A total of 4 patients (4/12, 33%) withdrew from the study (3 because of skin irritation and 1 because of patch connection issues). Patients wore biosensor patches at baseline and for 1-week post administration. Patient-reported outcomes (PROs) were collected at baseline, day 1, day 5, and day 8. No difference in the PRO was observed when nurses or patients applied the patch. PRO data indicated minimal impact on the patient’s life. Ease of use, influence on sleep, impact on follow-up of health, or discomfort with continuous monitoring did not change between baseline and day 8. Changes in PRO were observed on day 5, where a 20% (2/10) increase in skin irritation was reported. Withdrawals because of skin irritation were reported in all cases when wearing the second patch. Nurses reported the placement of the VitalPatch to be easy and felt measurements to be reliable. Conclusions: Generally, the VitalPatch was well tolerated and shown to be an attractive device because of its wearability and low impact on daily activities in patients, therefore making it suitable for implementation in future studies.

  • Source: AntonioGuillem; Copyright: AntonioGuillem; URL:; License: Licensed by the authors.

    Empirical Research on Acceptance of Digital Technologies in Medicine Among Patients and Healthy Users: Questionnaire Study


    Background: In recent years, interest in digital technologies such as electronic health, mobile health, telemedicine, big data, and health apps has been increasing in the health care sector. Acceptance and sustainability of these technologies play a considerable role for innovative health care apps. Objective: This study aimed to identify the spread of and experience with new digital technologies in the medical sector in Germany. Methods: We analyzed the acceptance of new health care technologies by applying the Technology Acceptance Model to data obtained in the German ePatient Survey 2018. This survey used standardized questionnaires to gain insight into the prevalence, impact, and development of digital health applications in a study sample of 9621 patients with acute and chronic conditions and healthy users. We extracted sociodemographic data and details on the different health app types used in Germany and conducted an evaluation based on the Technology Acceptance Model. Results: The average age of the respondents was 59.7 years, with a standard deviation of 16 years. Digital health care apps were generally accepted, but differences were observed among age groups and genders of the respondents. Men were more likely to accept digital technologies, while women preferred coaching and consultation apps. Analysis of the user typology revealed that most users were patients (n=4041, 42%), followed by patients with acute conditions (n=3175, 33%), and healthy users (n=2405, 25%). The majority (n=6542, 68%) discovered coaching or medication apps themselves on the internet, while more than half of the users faced initial difficulties operating such apps. The time of use of the same app or program ranged from a few days (n=1607, 37%) and several months (n=1694, 39%) to ≥1 year (n=1042, 24%). Most respondents (n=6927, 72%) stated that they would like to receive customized health care apps from their physician. Conclusions: The acceptance of digital technologies in the German health care sector varies depending on age and gender. The broad acceptance of medical digital apps could potentially improve individualized health care solutions and warrants governance.

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    Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care (The FACTS Study Phase II) After Surgical Abortion:...


    Background: Human-centered design is a methodology that applies an iterative participatory process that engages the end-user for whom an innovation or intervention is designed for from start to end. There is general evidence to support the use of human-centered design for development of tools to affect health behavior, but specifically for family planning provision. This study is part two of a three-phase study that uses a user-centered design methodology which uses the findings from Phase I to design, develop, and test a digital health solution to support follow-up after an induced surgical abortion. Objective: The objectives for this study were to: (1) develop a web-based intervention based on preferences and experiences of women who underwent an abortion as measured in the formative phase of the Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care Study; (2) conduct usability testing of the intervention to determine user-friendliness and appropriateness of the intervention; and (3) finalize a beta version of the web-based intervention for pilot testing. Methods: The study design was based on the “development-evaluation-implementation” process from the Medical Research Council Framework for Complex Medical Interventions. This study is in Phase II of III and is based on user-centered design methodology. Phase I findings demonstrated that women engage with technology to assist in clinical care and they preferred a comprehensive website with email or text notifications to support follow-up care. In Phase II we collaborated with family planning experts and key stakeholders to synthesize evidence from Phase I. With them and a development partner we built a prototype. Usability testing was completed with 9 participants using a validated System Usability Scale. This was then used to refine the intervention for Phase III pilot study. This study was approved by the local Ethics board. Results: We developed a comprehensive web-based tool called, which includes: Post-Procedure Care, Emotional Well-Being Tool, Contraception Explorer, Sexual Health, Book an Appointment, and Other Resources. Additionally, over the course of a month after the procedure, automatic email notifications were sent to women as a form of virtual follow-up support, directing them to resources. The web-based tool was refined based on usability testing results. Conclusions: This study demonstrated that user-centered design is a useful methodology to build programs and interventions that are women-centered, specifically for abortion care.

  • Source:; Copyright: John Tuesday; URL:; License: Licensed by JMIR.

    Identification of Factors That Motivate People With Multiple Sclerosis to Participate in Digital Data Collection in Research: Sequential Mixed Methods Study


    Background: Digital data collection has the potential to reduce participant burden in research projects that require extensive registrations from participants. To achieve this, a digital data collection tool needs to address potential barriers and motivations for participation. Methods: The study was designed as a sequential mixed-methods study with 3 phases. In phase 1, 15 semistructured interviews were conducted in a Danish population of individuals with MS. Interview guide frameworks were based on dimensions from the electronic health literacy framework and the Health Education Impact Questionnaire. Data from phase 1 were analyzed in a content analysis, and findings were used to inform the survey design in phase 2 that validates the results from the content analysis in a larger population. The survey consisted of 14 items, and it was sent to 1000 individuals with MS (response rate 42.5%). In phase 3, participants in 3 focus group interviews discussed how findings from phases 1 and 2 might affect motivation for participation and adoption of the digital tool. Results: The following 3 categories related to barriers and incentives for participation were identified in the content analysis of the 15 individual interviews: (1) life with MS, (2) use of technology, and (3) participation and incentives. Phase 1 findings were tested in phase 2’s survey in a larger population (n=1000). Majority of participants were comfortable using smartphone technologies and participated actively on social media platforms. MS symptoms did cause limitations in the use of Web pages and apps when the given pages had screen clutter, too many colors, or too small buttons. Life with MS meant that most participants had to ration their energy levels. Support from family and friends was important to participants, but support could also come in the form of physical aids (walking aids and similar) and digital aids (reminders, calendar functions, and medication management). Factors that could discourage participation were particularly related to the time it would take every day. Biggest motivations for participation were to contribute to research in MS, to learn more about one’s own MS and what affects it, and to be able to exchange experiences with other people with MS. Conclusions: MS causes limitations that put demands on the tool developed for digital data collection. A digital data collection tool can increase chances of high adoption rates, but the tool needs to be supplemented with clear and simple project design and continuous communication with participants. Motivational factors should be considered for both study design and the development of a digital data collection tool for research.

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    Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study


    Background: There is limited published data on variation in physician usage of electronic health records (EHRs), particularly after hours. Research in this area could provide insight into the effects of EHR-related workload on physicians. Objective: This study sought to examine factors associated with after-hours EHR usage among primary care physicians. Methods: Electronic health records usage information was collected from primary care pediatricians in a large United States hospital. Inclusion criteria consisted solely of being a primary care physician who started employment with the hospital before the study period, so all eligible primary care physicians were included without sampling. Mixed effects statistical modeling was used to investigate the effects of age, gender, workload, normal-hour usage, week to week variation, and provider to provider variation on the after-hour usage of EHRs. Results: There were a total of 3498 weekly records obtained on 50 physicians, of whom 22% were male and 78% were female. Overall, more EHR usage during normal work hours was associated with decreased usage after hours. The more work relative value units generated by physicians, the more time they spent interacting with EHRs after hours (β=.04, P<.001) and overall (ie, during normal hours and after hours) (β=.24, P<.001). Gender was associated with total usage time, with females spending more time than males (P=.03). However, this association was not observed with after-hours EHR usage. Provider to provider variation was the largest and most dominant source of variation in after-hour EHR usage, which accounted for 52% of variance of total EHR usage. Conclusion: The present study found that there is a considerable amount of variability in EHR use among primary care physicians, which suggested that many factors influence after-hours EHR usage by physicians. However, provider to provider variation was the largest and most dominant source of variation in after-hours EHR usage. While the results are intuitive, future studies should consider the effect of EHR use variations on workload efficiency.

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  • Applying a Human Centered Design to develop a patient prioritization tool for a pediatric emergency department

    Date Submitted: Feb 26, 2020

    Open Peer Review Period: Feb 26, 2020 - Apr 26, 2020

    Background: Overcrowding in the emergency departments has become an increasingly significant problem. Patient triage strategies are acknowledged to help clinicians manage patient flow and reduce patie...

    Background: Overcrowding in the emergency departments has become an increasingly significant problem. Patient triage strategies are acknowledged to help clinicians manage patient flow and reduce patients’ waiting time. Yet, electronic patient triage systems are not developed so that they comply with clinicians’ work’s habits. Objective: This case study presents the development of a patient prioritization tool (PPT) and of the related patient prioritization algorithm (PPA) for a pediatric emergency department (PED) relying on a human-centered design process. Methods: We followed a human-centered design process: (i) we performed a work system analysis through observations and interviews in an academic hospital’s PED; (ii) design specifications were deduced; (iii) we designed a PPT and the related PPA; and (iv) we performed user testing to validate the tool suits clinicians’ habits of works. Results: We developed mockups of the PPT along with the PPA. The mock PPT gives the status of patients progressing through the PED in an intuitive and immediately understandable way along with an overview of all the patients in the PED. The PPA can automatically be fed with data from a patient management software, calculate the status of each patient in real-time, and moves them through the PPT interface, thus showing the patients’ suggested level of priority. Conclusions: This case study showed the value of integrating human factors into the design process for a PPT for PED. A PPT complying with the work habits of the clinicians is more likely to be accepted and used and may contribute to help reduce overcrowding in PED.