title: Applying Human Factors Principles to Mitigate Usability Issues Related to Embedded Assumptions in Health Information Technology Design.
abstract: BACKGROUND
  There is growing recognition that design flaws in health information technology (HIT) lead to increased cognitive work, impact workflows, and produce other undesirable user experiences that contribute to usability issues and, in some cases, patient harm. These usability issues may in turn contribute to HIT utilization disparities and patient safety concerns, particularly among "non-typical" HIT users and their health care providers. Health care disparities are associated with poor health outcomes, premature death, and increased health care costs. HIT has the potential to reduce these disparate outcomes. In the computer science field, it has long been recognized that embedded cultural assumptions can reduce the usability, usefulness, and safety of HIT systems for populations whose characteristics differ from "stereotypical" users. Among these non-typical users, inappropriate embedded design assumptions may contribute to health care disparities. It is unclear how to address potentially inappropriate embedded HIT design assumptions once detected.
  
  
  OBJECTIVE
  The objective of this paper is to explain HIT universal design principles derived from the human factors engineering literature that can help to overcome potential usability and/or patient safety issues that are associated with unrecognized, embedded assumptions about cultural groups when designing HIT systems.
  
  
  METHODS
  Existing best practices, guidance, and standards in software usability and accessibility were subjected to a 5-step expert review process to identify and summarize those best practices, guidance, and standards that could help identify and/or address embedded design assumptions in HIT that could negatively impact patient safety, particularly for non-majority HIT user populations. An iterative consensus-based process was then used to derive evidence-based design principles from the data to address potentially inappropriate embedded cultural assumptions.
  
  
  RESULTS
  Design principles that may help identify and address embedded HIT design assumptions are available in the existing literature.
  
  
  CONCLUSIONS
  Evidence-based HIT design principles derived from existing human factors and informatics literature can help HIT developers identify and address embedded cultural assumptions that may underlie HIT-associated usability and patient safety concerns as well as health care disparities.
authors.affiliation: Johns Hopkins University, Departments of Medicine, Public Health, and Health Informatics, Baltimore, MD, United States. mgibbon1@jhu.edu.
authors.forename: Michael C
authors.identifier: http://orcid.org/0000-0002-5990-902X
authors.initials: MC
authors.lastname: Gibbons
authors.forename: Svetlana Z
authors.initials: SZ
authors.lastname: Lowry
authors.forename: Emily S
authors.initials: ES
authors.lastname: Patterson
keywords: EHR; cultural ergonomics; culturally informed design; health care disparities; health information technology; human factors; patient portal; patient safety; usability; workflow