title: Impact of clinical reminder redesign on learnability, efficiency, usability, and workload for ambulatory clinic nurses.
abstract: OBJECTIVE
  Computerized clinical reminders (CRs) were designed to reduce clinicians' reliance on their memory and to present evidence-based guidelines at point of care. However, the literature indicates that CR adoption and effectiveness has been variable. We examined the impact of four design modifications to CR software on learnability, efficiency, usability, and workload for intake nursing personnel in an outpatient clinic setting. These modifications were included in a redesign primarily to address barriers to effective CR use identified during a previous field study.
  
  
  METHODS
  In a simulation experiment, 16 nurses used prototypes of the current and redesigned system in a within-subject comparison for five simulated patient encounters. Prior to the experimental session, participants completed an exploration session, where "learnability" of the current and redesigned systems was assessed.
  
  
  METHODS
  Time, performance, and survey data were analyzed in conjunction with semi-structured debrief interview data.
  
  
  RESULTS
  The redesign was found to significantly increase learnability for first-time users as measured by time to complete the first CR, efficiency as measured by task completion time for two of five patient scenarios, usability as determined by all three groupings of questions taken from a commonly used survey instrument, and two of six workload subscales of the NASA Task Load Index (TLX) survey: mental workload and frustration.
  
  
  CONCLUSIONS
  Modest design modifications to existing CR software positively impacted variables that likely would increase the willingness for first-time nursing personnel to adopt and consistently use CRs.
authors.affiliation: Veterans Association Getting at Patient Safety (GAPS) Center, VAMC, Cincinnati, OH, USA. jsaleem@iupui.edu
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Saleem
authors.forename: Emily S
authors.initials: ES
authors.lastname: Patterson
authors.forename: Laura
authors.initials: L
authors.lastname: Militello
authors.forename: Shilo
authors.initials: S
authors.lastname: Anders
authors.forename: Mercedes
authors.initials: M
authors.lastname: Falciglia
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Wissman
authors.forename: Emilie M
authors.initials: EM
authors.lastname: Roth
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D001292:Attitude to Computers; D004526:Efficiency; D006751:Hospital Information Systems / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D007858:Learning; D048108:Nursing Informatics / Q000193:education*; D009740:Nursing Staff; D009820:Ohio; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D017010:Reminder Systems / Q000706:statistics & numerical data; D012984:Software; D014584:User-Computer Interface; D000078329:Workforce; D016526:Workload