Safety-enhanced design (MU3))

Overview

Working with Columbia HIT.

Criteria that are testing

• a1: Computerized provider order entry (CPOE) – medications (task 2)
• a2: CPOE – laboratory (task 4)
• a5: Demographics (task 1)
• a9: Clinical decision support (task 1)
• a14: Implantable device list (task 3)

Research

Actual rule:

• https://www.healthit.gov/test-method/safety-enhanced-design

Example reports:

• https://content-main.ul.com/sites/g/files/qbfpbp306/files/2020-08/BlueEHR-2.0-SED-Report.pdf
• https://slicompliance.com/wp-content/uploads/2022/01/Prime-Clinical-EHR-Usability-Test-Report.pdf
• https://slicompliance.com/wp-content/uploads/2022/01/FreeChiro_18_SED_Report.pdf
• https://slicompliance.com/wp-content/uploads/2021/12/Strateq_EHR_UsabilityReport_08Dec2021.pdf

Usability demos

• There are 3 duplicate demos that contain 1 patient (Ed Smith with one encounter) with one lab option (PSA) and with ICD10 code set installed and one provider (the admin user with name of Frank Johnson). Demos can be reset after the test is complete. Demos also reset daily at around 1:00 am pacific time. When demos reset, they are rebuilt on top of most recent codebase. Demos use private credentials (ie. public will not be able to access them).

• Usability Demo A
• Usability Demo B
• Usability Demo C

Usability testing scenario

• Ed Smith is a patient in your clinic. In this scenario, the user will modify this patient's demographics, enter in a medication order for this patient, add a implantable device for this patient, and order a lab for this patient.

• Below task material is for training for users. The following is the testing guide that will be used during testing by the users: Usability Testing Guide

Task 1: Enter and modify demographics.

• Testing overview:

• Edit demographics for 'Ed Smith'

• Gender Identity choose 'Identifies as Male'
• Sexual Orientation choose 'Straight or Heterosexual'
• DOB change to '1968-12-30'

• After saving above demographic changes, clinical decision support will display window with new due reminders based off age (including Colon Cancer Screening).

• Specific testing steps:

Enter 'Smith' in patient selector at top right and then click the search icon/button.

Click the 'Smith, Ed' patient.

Click the edit icon/button for Demographics.

Gender Identity set 'Identifies as Male'. Sexual Orientation set 'Straight or Heterosexual'. DOB change to '1968-12-30'. Then click 'Save'.

Click 'OK'.

Task 2: Enter in medication order.

• Item tested:

• a1: Computerized provider order entry (CPOE) – medications

• Testing overview:

• Add prescription for 'Ed Smith'

• Lipitor 20mg tabs Per Oris q.d. with quantity of 30

• Specific testing steps:

Scroll to bottom of patient summary screen and click the edit icon/button for Prescriptions.

Click 'Add'

Enter 'Lipitor' in the textbox and then select the Lipitor entry.

Enter Quantity 30. Enter Medicine Units 20 mg. Enter Directions 1 in tablet Per Oris q.d. Then click 'Save'.

Click 'Quit'.

Task 3: Add a implantable device.

• Item tested:

• a14: Implantable device list

• Testing overview:

• Add Implantable Device for 'Ed Smith'

• UDI is (01)00889095205923(11)141231(17)150707(10)A213B1(21)1234

• Specific testing steps:

Click 'Issues' at top of patient summary screen.

Click 'Add' at Medical Devices.

Paste following into UDI textbox: (01)00889095205923(11)141231(17)150707(10)A213B1(21)1234
Then click 'Process UDI'.

This is what screen looks like after clicking 'Process UDI'.

Then scroll down and click 'Save'.

Task 4: Order a lab.

• Item tested:

• a2: CPOE – laboratory

• Testing overview:

• Order lab for 'Ed Smith'

• PSA

• Specific testing steps:

Click 'Visit Past Encounters' at top of screen.

Click '2022-01-18 Office Visit' from dropdown.

In encounter menu, click 'Administrative', then click 'Procedure Order'.

Click Procedure Test textbox.

Enter 'PSA' and click 'Search'.

Click 'psa_level_order'.

Click 'Save'.