Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was...
-
Upload
meghan-manning -
Category
Documents
-
view
214 -
download
0
Transcript of Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was...
![Page 1: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/1.jpg)
Usability & Human Factors
Designing for Safety
Lecture c
This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.
![Page 2: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/2.jpg)
Designing for SafetyLearning Objectives
2
• Design a workflow analysis study (Lecture c)
• Identify common sources of error documented in research studies in medicine (Lecture c)
• Apply principles underlying the design of healthcare systems for safety (Lecture c)
Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 3: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/3.jpg)
Medical Error Reporting
3Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 4: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/4.jpg)
Koppel – Patient Safety
4Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 5: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/5.jpg)
Koppel
5Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 6: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/6.jpg)
Koppel – Study of Workaround to Barcode
Medication Administration
6Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 7: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/7.jpg)
Koppel – (cont.)
7Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 8: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/8.jpg)
Koppel – Medication Workarounds (cont.)
8Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 9: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/9.jpg)
Probable Causes of Workarounds (Koppel)
9Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 10: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/10.jpg)
Prevention of Errors From Workarounds
10Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 11: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/11.jpg)
Koppel – JAMA 2005 – Role of CPOE in Facilitating Errors
11Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 12: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/12.jpg)
Walker - 2008
12Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 13: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/13.jpg)
Walker (cont.)
13Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 14: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/14.jpg)
Recommended Prevention/Management
Strategies
14Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 15: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/15.jpg)
Prevention (cont.)
15Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 16: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/16.jpg)
Canada – Health Infoway
https://www2.infoway-inforoute.ca/Documents/EHR-Patient%20Safety%20Report.pdf
16Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 17: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/17.jpg)
Problem – Lack of Knowledge
17Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 18: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/18.jpg)
Design Patterns and New Methods
18Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 19: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/19.jpg)
Bad Informatics Examples and Solutions
19Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 20: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/20.jpg)
Multiple Name Formats
J N Tobias Tobias, JJ Noel Tobias Tobias, J NJ Tobias Tobias, J NoelJNTobias Tobias, JonahJonah N Tobias Tobias, Jonah NJonah Noel Tobias Tobias, Jonah NoelJonah Tobias TobiasJJonahNTobias TobiasJNJTobias Tobias J NTobias J TobiasJonahNTobias J N TobiasJonahNoel
1.1 Table: Senathirajah, Y. (2010).
20Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 21: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/21.jpg)
Methods of Preventing Error – Tall Man Lettering
Senathirajah, Y. (2010).
21Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 22: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/22.jpg)
Regulation?
22Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 23: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/23.jpg)
Designing for SafetySummary
23Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 24: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/24.jpg)
Resources
24Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 25: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/25.jpg)
Designing for SafetyReferences – Lecture c
Reference
1. Zhang, J., Patel, L.V., Johnson, R. T., &. Shortliffe, H.E. (2004). A cognitive taxonomy of medical errors. Journal of Biomedical Informatics 37:193–204
2. Koppel, R., and Kreda, K. (2009). Health Care Information Technology Vendors’ “Hold Harmless” Clause: implications for patients and clinicians., JAMA.2009; 301:1276-1278.
3. Koppel, R., Metlay, J.P., Cohen, A., et. al. (2005). Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293:1197-1203.
4. Koppel, R. (2010). EMR entry error: not so benign. AHRQ Morbidity and Mortality Rounds on the Web. Case & Commentary: Medicine, April 2010. Available at http://www.webmm.ahrq.gov/case.aspx?caseID=199
5. Koppel, R. (2008). Wetterneck T, Telles JL, Karsh BT. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc. 2008 Jul-Aug;15(4):408-23.
6. Koppel, R., Metlay, J.P., Cohen, A., Abaluck, B., Localio, A.R., Kimmel, S.E., et. al. (2005). Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005 Mar 9;293(10):1197-203.
7. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human. Committee on Quality of Healthcare in America Institute of Medicine. Washington, DC: National Academy Press; 1999.
8. Walker, J.M., Carayon, P., Levesond. N., Paulus, R.A., Tookere, J., Chin, H., Bothe, A. Jr., Stewart, W.F. (2008). Perspectives on Informatics EHR Safety: The Way Forward to Safe and Effective Systems. JAMIA 2008
9. Interview with Ross Koppel http://histalk2.com/2009/08/12/histalk-interviews-ross-koppel/
25Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c
![Page 26: Usability & Human Factors Designing for Safety Lecture c This material (Comp15_Unit10c) was developed by Columbia University, funded by the Department.](https://reader036.fdocuments.net/reader036/viewer/2022062802/56649e9c5503460f94b9d51a/html5/thumbnails/26.jpg)
Designing for SafetyReferences – Lecture c
Images
Slide 16: Electronic Health Records and Patient Safety A joint report on Future Directions for Canada. Canada Health Infoway. Retrieved on September 8th, 2010 from
https://www2.infoway-inforoute.ca/Documents/EHR-Patient%20Safety%20Report.pdf
Slide 21: Senathirajah, Y. (2010). Department of Biomedical Informatics, Columbia University Medical Center, New York, NY.
Charts, Tables & Figures
1.1 Table: Senathirajah, Y. (2010). Department of Biomedical Informatics, Columbia University Medical Center, New York, NY.
26Health IT Workforce Curriculum Version 3.0/Spring 2012
Usability & Human Factors Designing for Safety
Lecture c