Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: A systematic review

Selvana Awad; Krestina Amon; Andrew Baillie; Thomas Loveday; Melissa T Baysari

doi:10.1016/j.ijmedinf.2023.105017

Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: A systematic review

Int J Med Inform. 2023 Apr:172:105017. doi: 10.1016/j.ijmedinf.2023.105017. Epub 2023 Feb 9.

Authors

Selvana Awad¹, Krestina Amon², Andrew Baillie³, Thomas Loveday⁴, Melissa T Baysari²

Affiliations

¹ Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; eHealth NSW, Australia. Electronic address: sawa9744@uni.sydney.edu.au.
² Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
³ Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Australia; Sydney Local Health District, Australia.
⁴ eHealth NSW, Australia.

PMID: 36809716
DOI: 10.1016/j.ijmedinf.2023.105017

Abstract

Introduction: Poorly designed electronic medication management systems (EMMS) or computerized physician order entry (CPOE) systems in hospital settings can result in usability issues and in turn, patient safety risks. As a safety science, human factors and safety analysis methods have potential to support the safe and usable design of EMMS.

Objective: To identify and describe human factors and safety analysis methods that have been used in the design or redesign of EMMS used in hospital settings.

Materials and methods: A systematic review, following PRISMA guidelines, was conducted by searching online databases and relevant journals from January 2011 to May 2022. Studies were included if they described the practical application of human factors and safety analysis methods to support the design or redesign of a clinician-facing EMMS, or its components. Methods used were extracted and mapped to human centered design (HCD) activities: understanding context of use; specifying user requirements; producing design solutions; and evaluating the design.

Results: Twenty-one papers met the inclusion criteria. Overall, 21 human factors and safety analysis methods were used in the design or redesign of EMMS with prototyping, usability testing, participant surveys/questionnaires and interviews the most frequent. Human factors and safety analysis methods were most frequently used to evaluate the design of a system (n = 67; 56.3%). Nineteen of 21 (90%) methods used aimed to identify usability issues and/or support iterative design; only one paper utilized a safety-oriented method and one, a mental workload assessment method.

Discussion and conclusion: While the review identified 21 methods, EMMS design primarily utilized a subset of available methods, and rarely a method focused on safety. Given the high-risk nature of medication management in complex hospital environments, and the potential for harm due to poorly designed EMMS, there is significant potential to apply more safety-oriented human factors and safety analysis methods to support EMMS design.

Keywords: Design; Digital health; Human factors; Safety.

Publication types

Systematic Review
Review

MeSH terms

Humans
Medical Order Entry Systems*
Medication Systems, Hospital
Medication Therapy Management*
Patient Safety