title: User Interface Problems of a Nationwide Inpatient Information System: A Heuristic Evaluation.
abstract: BACKGROUND
  While studies have shown that usability evaluation could uncover many design problems of health information systems, the usability of health information systems in developing countries using their native language is poorly studied. The objective of this study was to evaluate the usability of a nationwide inpatient information system used in many academic hospitals in Iran.
  
  
  METHODS
  Three trained usability evaluators independently evaluated the system using Nielsen's 10 usability heuristics. The evaluators combined identified problems in a single list and independently rated the severity of the problems. We statistically compared the number and severity of problems identified by HIS experienced and non-experienced evaluators.
  
  
  RESULTS
  A total of 158 usability problems were identified. After removing duplications 99 unique problems were left. The highest mismatch with usability principles was related to "Consistency and standards" heuristic (25%) and the lowest related to "Flexibility and efficiency of use" (4%). The average severity of problems ranged from 2.4 (Major problem) to 3.3 (Catastrophe problem). The experienced evaluator with HIS identified significantly more problems and gave higher severities to problems (p<0.02).
  
  
  CONCLUSIONS
  Heuristic Evaluation identified a high number of usability problems in a widely used inpatient information system in many academic hospitals. These problems, if remain unsolved, may waste users' and patients' time, increase errors and finally threaten patient's safety. Many of them can be fixed with simple redesign solutions such as using clear labels and better layouts. This study suggests conducting further studies to confirm the findings concerning effect of evaluator experience on the results of Heuristic Evaluation.
authors.affiliation: Student Research Committee, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Cancer Informatics Department, Breast Cancer Research Center, ACECR, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Atashi
authors.affiliation: Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Health Information Management and Technology, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Khajouei
authors.affiliation: Student Research Committee, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Amirabbas
authors.initials: A
authors.lastname: Azizi
authors.affiliation: Student Research Committee, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Dadashi
mesh_terms: D063005:Health Information Systems; D000066506:Heuristics; D006801:Humans; D007297:Inpatients; D014584:User-Computer Interface
keywords: Heuristic Evaluation; Hospital information systems; health information systems; inpatients; usability; user-computer interface