Publikationen

Patientendatenmangementsysteme (PDMS) sind computerbasierte Systeme zur Verarbeitung von medizinischen Daten, die auf Intensivstationen sowohl positive als auch negative Einflüsse auf die Patientenversorgung haben können. Die Faktoren, die darüber entscheiden, ob ein PDMS eher Vor- oder Nachteile bringt und wie deutlich diese ausfallen, werden unter dem Begriff „Gebrauchstauglichkeit“ zusammengefasst. Diese Arbeit fasst die Ergebnisse aus 3 bereits publizierten Arbeiten zu diesem Thema zusammen.

Introduction:The term “usability” describes how effectively, efficiently, and with what level of user satisfaction an information system can be used to accomplish specific goals. Computerized critical care information systems (CCISs) with high usability increase quality of care and staff satisfaction, while reducing medication errors. Conversely, systems lacking usability can interrupt clinical workflow, facilitate errors, and increase charting time. The aim of this study was to investigate and compare usability across CCIS currently used in Germany.Methods:In this study, German intensive care unit (ICU) nurses and physicians completed a specialized, previously validated, web-based questionnaire. The questionnaire assessed CCIS usability based on three rating models: an overall rating of the systems, a model rating technical usability, and a model rating task-specific usability.Results:We analyzed results from 535 survey participants and compared eight different CCIS commonly used in Germany. Our results showed that usability strongly differs across the compared systems. The system ICUData had the best overall rating and technical usability, followed by the platforms ICM and MetaVision. The same three systems performed best in the rating of task-specific usability without significant differences between each other. Across all systems, overall ratings were more dependent on ease-of-use aspects than on aspects of utility/functionality, and the general scope of the functions offered was rated better than how well the functions are realized.Discussion:Our results suggest that manufacturers should shift some of their effort away from the development of new features and focus more on improving the ease-of-use and quality of existing features.

Introduction: Critical care information systems (CCIS) are computer software systems specialized for supporting the data processing tasks of clinical staff in intensive care units (ICUs). Reports on the impact of CCIS vary strongly from large benefits to harmful impact. One factor causing these inconsistent results is a large functional heterogeneity of the currently available systems, as no standards exist. Therefore, the aim of this study was to derive recommendations for a minimum range of functions that CCIS should incorporate from the perspective of clinical users.
Materials and Methods: We performed a web-based survey targeting clinical ICU staff in Germany. Participants rated the usefulness of pre-defined CCIS functions (36 for physicians / 31 for nurses) between 0-5. To capture confounders that might influence the ratings, we recorded 18 individual and workplace characteristics.
Results: The 912 participants rated all but three of the investigated functions as useful with median scores of 4-5. A multivariable analysis showed that the ratings were influenced by whether CCIS were used on the participants’ wards, by the rating of the function quality of the used CCIS, the years of work experience and whether the participant was a physician or a nurse.
Conclusions: Clinical ICU staff considers all but three of the here investigated CCIS functions as useful. Even though we identified a variety of factors influencing the usefulness ratings, their influence is rather small and thus does not limit the validity of our findings. Accordingly, we commend the functions identified as useful to be incorporated in CCIS.

The implementation of computerized critical care information systems (CCIS) can improve the quality of clinical care and staff satisfaction, but also holds risks of disrupting the workflow with consecutive negative impacts. The usability of CCIS is one of the key factors determining their benefits and weaknesses. However, no tailored instrument exists to measure the usability of such systems. Therefore, the aim of this study was to design and validate a questionnaire that measures the usability of CCIS. Following a mixed-method design approach, we developed a questionnaire comprising two evaluation models to assess the usability of CCIS: (1) the task-specific model rates the usability individually for several tasks which CCIS could support and which we derived by analyzing work processes in the ICU; (2) the characteristic-specific model rates the different aspects of the usability, as defined by the international standard “ergonomics of human-system interaction”. We tested validity and reliability of the digital version of the questionnaire in a sample population. In the sample population of 535 participants both usability evaluation models showed a strong correlation with the overall rating of the system (multiple correlation coefficients ≥0.80) as well as a very high internal consistency (Cronbach’s alpha ≥0.93). The novel questionnaire is a valid and reliable instrument to measure the usability of CCIS and can be used to study the influence of the usability on their implementation benefits and weaknesses.

The aim is to demonstrate the benefit of the medico-ergonomic approach for the redesign of clinical work systems. Based on the six layer model, a concept for an ‘integrated therapy safety management’ is drafted. This concept could serve as a basis to improve resilience. Methods The concept is developed through a concept-based approach. The state of the art of safety and complexity research in human factors and ergonomics forms the basis. The findings are synthesized to a concept for ‘integrated therapy safety management’. The concept is applied by way of example for the ‘medication process’ to demonstrate its practical implementation. Results The ‘integrated therapy safety management’ is drafted in accordance with the six layer model. This model supports a detailed description of specific work tasks, the corresponding responsibilities and related workflows at different layers by using the concept of ‘bridge managers’. ‘Bridge managers’ anticipate potential errors and monitor the controlled system continuously. If disruptions or disturbances occur, they respond with corrective actions which ensure that no harm results and they initiate preventive measures for future procedures. The concept demonstrates that in a complex work system, the human factor is the key element and final authority to cope with the residual complexity. The expertise of the ‘bridge managers’ and the recursive hierarchical structure results in highly adaptive clinical work systems and increases their resilience. Conclusions The medico-ergonomic approach is a highly promising way of coping with two complexities. It offers a systematic framework for comprehensive analyses of clinical work systems and promotes interdisciplinary collaboration.

The importance of technology for the medical sector is steadily growing. Potentials for rationalization that can help to overcome the problems of an ageing population exist. So far these expectations could not be fulfilled because some devices lack a sufficient usability concept and do not fulfill the user demands. This chapter will illustrate problems that can arise when developing user-centered and task-oriented “health care applications.” The “medico ergonomics approach” is introduced as a possibility to overcome these problems. The applicability of the developed approach is demonstrated with the help of a case study. Content of this case study is a usability context analysis of a web-based patient record. The case study shows the suitability of the medico ergonomic models to illustrate complex interrelations of patient treatment. Based on these results requirements are defined and task-supporting functions are derived. The models support the development of a “common ground of understanding” between the potential user and the developers of the product. This is a crucial condition for developing integrated and utilizable (software) products and therewith for developing ergonomic working systems.

Assistive Technologien bieten ein großes Potenzial auch zukünftig eine bedarfsgerechte (Gesundheits-)Versorgung aufrechtzuerhalten. Für ihren erfolgreichen Einsatz ist aber ein ganzheitlicher Ansatz zur Sicherung der ergonomischen Qualität medizinischer Arbeitssysteme notwendig. Ziel des vorliegenden Beitrags ist, eine ganzheitliche Vorgehenssystematik zur ergonomischen Gestaltung medizinischer Arbeitssysteme zu skizzieren. Eine Analyse identifiziert drei Vorgehensmodelle: Der EQUID-Ansatz verfolgt das Ziel, ergonomische Erkenntnisse und Methoden während der Produktentwicklung systematisch zu integrieren. Normative Vorgaben, wie die DIN EN ISO 6385:2004 definieren das Vorgehen zur ergonomischen Gestaltung von Arbeitssystemen. Für die Entwicklung von Medizinprodukte definieren die DIN EN 60601-1-6 und die DIN EN 62366 einen Ergonomieprozess, mit dem Ziel, die Anwendersicherheit zu erhöhen. Das Vorgehensmodell zur Organisationsgestaltung beschreibt einen standardisierten Ablauf zur Unterstützung von Organisationsveränderungen. Auf Basis dieser drei Vorgehensmodelle wurde eine Vorgehenssystematik für die ergonomische Gestaltung medizinischer Arbeitssysteme entworfen. Sie gliedert sich in drei Ebenen: Die erste Ebene definiert einzelne Gestaltungsphasen. Die zu erfüllenden Aufgaben beschreibt die zweite Ebene. Die dritte Ebene beinhaltet arbeitswissenschaftliche Methoden und Modelle, die speziell auf das medizinische Arbeitssystem ausgerichtet sind: das PAMS-, TaPTa- und das CIPU-Modell. Die beschrieben Systematik könnte helfen, Barriere, die bei der ergonomischen Gestaltung medizinischer Arbeitssysteme derzeit noch bestehen, zu überwinden. Dazu ist die Konkretisierung der Systematik und dessen Evaluierung in Pilotprojekten geplant.