University Health Network (UHN), Canada’s largest research hospital, is in the process of implementing an electronic system for managing all documentation completed by its anesthesiologists. This represents a dramatic shift in their workflow as their current practice of documenting on a tri-fold paper form, will be replaced with electronic systems at the point of care. Selecting a system that fails to consider workflow, user needs and limitations, not only runs the risk of poor adoption, but could also have patient safety implications if the system is difficult to understand and use.
Anesthesiologists were shadowed throughout the peri-operative process to map their tasks, information requirements, communication methods and any issues or bottlenecks. This resulted in a clear understanding of their processes and a prioritization of their requirements for an Anesthesia Information Management System (AIMS). These requirements were then used to develop realistic usability test scenarios which were used in simulated pre, intra and post operative lab environments to assess and predict how well each system would support anesthesiology practice at UHN.
Seventeen anesthesiologists participated in three scenarios with each of the three short-listed systems being evaluated. This yielded substantial contextual information on what aspects of the systems were difficult to use, poorly organized, or required further customization to support workflow. In addition quantitative measures such as task completion time and error rates were collected and analysed together with subjective participant survey data against the prioritized requirements to select a system to be purchased.
The scope of the Anesthesia Information Management System project was later broadened to include clinical documentation beyond the post anesthetic care unit to other critical care units. As such, additional systems and requirements were also considered.