title: Evaluating the Usability and Perceived Impact of an Electronic Medical Record Toolkit for Atrial Fibrillation Management in Primary Care: A Mixed-Methods Study Incorporating Human Factors Design.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a common and preventable cause of stroke. Barriers to reducing stroke risk through appropriate prescribing have been identified at the system, provider, and patient levels. To ensure a multifaceted initiative to address these barriers is effective, it is essential to incorporate user-centered design to ensure all intervention components are optimized for users.
  
  
  OBJECTIVE
  To test the usability of an electronic medical record (EMR) toolkit for AF in primary care with the goal of further refining the intervention to meet the needs of primary care clinicians.
  
  
  METHODS
  An EMR-based toolkit for AF was created and optimized through usability testing and iterative redesign incorporating a human factors approach. A mixed-methods pilot study consisting of observations, semi-structured interviews, and surveys was conducted to examine usability and perceived impact on patient care and workflow.
  
  
  RESULTS
  A total of 14 clinicians (13 family physicians and 1 nurse practitioner) participated in the study. Nine iterations of the toolkit were created in response to feedback from clinicians and the research team; interface-related changes were made, additional AF-related resources were added, and functionality issues were fixed to make the toolkit more effective. After improvements were made, clinicians expressed that the toolkit improved accessibility to AF-related information and resources, served as a reminder for guideline-concordant AF management, and was easy to use. Most clinicians intended to continue using the toolkit for patient care. With respect to impact on care, clinicians believed the toolkit increased the thoroughness of their assessments for patients with AF and improved the quality of AF-related care received by their patients.
  
  
  CONCLUSIONS
  The positive feedback surrounding the EMR toolkit for AF and its perceived impact on patient care can be attributed to the adoption of a user-centered design that merged clinically important information about AF management with user needs. This study demonstrates the utility of a human factors approach to piloting and refining an intervention prior to wide-scale implementation.
authors.affiliation: OpenLab, University Health Network, Toronto, ON, Canada. kim.tran2@uhn.ca.
authors.forename: Kim
authors.identifier: http://orcid.org/0000-0003-1009-0954
authors.initials: K
authors.lastname: Tran
authors.forename: Kori
authors.identifier: http://orcid.org/0000-0002-9996-0663
authors.initials: K
authors.lastname: Leblanc
authors.forename: Alissia
authors.identifier: http://orcid.org/0000-0003-3683-8342
authors.initials: A
authors.lastname: Valentinis
authors.forename: Doug
authors.identifier: http://orcid.org/0000-0002-1105-0316
authors.initials: D
authors.lastname: Kavanagh
authors.forename: Nina
authors.identifier: http://orcid.org/0000-0002-1687-3610
authors.initials: N
authors.lastname: Zahr
authors.forename: Noah M
authors.identifier: http://orcid.org/0000-0003-2500-2435
authors.initials: NM
authors.lastname: Ivers
keywords: primary health care, atrial fibrillation, electronic health records, mixed-methods research, evidence-based medicine