Using Human Factors and Systems Simulation to Optimize the Usability of a Code Documentation Tool

Objectives: Implementing a new electronic health record (EHR) system in high-pressure, high-stakes environments, such as documenting during pediatric and neonatal cardiac and respiratory arrest scenarios, can be challenging for health care staff. Poorly designed tools or technology that don’t align with existing workflows may lead to incomplete or inaccurate documentation. Lower adoption rates and continued reliance on paper forms for code documentation can result in gaps in patient data within the EHR, requiring the transcription of critical information after the event. Methods: This project utilized human factors usability testing and systems-focused simulation evaluation methods to assess code documentation tools with end-users from critical care areas (ED, ICU, NICU) during the EHR design phase. Results: A total of 202 recommendations to enhance the EHR’s usability and functionality were made across the 3 testing cycles (2 rounds of usability testing and 1 cycle of systems simulation sessions). The majority of recommendations were focused on improvements to the software and technology of the code narrator tool directly. Post-launch assessment showed that nearly 2/3 of the usability recommendations were implemented within the first year of use. Conclusions: Improving the design of these tools and ensuring seamless workflow integration is essential for increasing adoption and enhancing the accuracy of patient records.