Introduction/aims: Secure messaging is a Web-based message system within a personal health record system that allows healthcare teams and their patients to communicate nonurgent, health-related information in a private and safe computer environment. Recent studies have shown that usability of health records is a significant concern for credentialed providers and is a potential obstacle to system adoption. The objectives of this project were to examine usability patterns of this communication tool and to compare the experiences of users to assist in overcoming implementation barriers and to promote new system capabilities for pediatric providers.
Methods/process/procedures: This study used a mixed-methods study design using a convenience sample from three hospitals following institutional review board approval. For the first phase, data were collected from 61 pediatric providers to include physicians, nurse practitioners, nurses, and medical technicians using an online version of a highly reliable survey tool ([alpha] = .91). The Questionnaire for User Interaction Satisfaction 7.0 consisted of 43 questions and 11 sections: general demographics, current system experience, past computer experience, overall system satisfaction, screen characteristics, technology and system information, ease of learning, online help availability, training methodologies, multimedia availability, and future capabilities. For the second phase of the study, three focus groups were conducted. Twenty-one subjects participated discussing how secure messaging was currently used in their practice, current barriers, opportunities, and upcoming design considerations for upgrades of this patient engagement tool. Zhang and Walji's conceptual framework for electronic health record (EHR) usability, called TURF (Tasks, Users, Representations, and Functions), was used throughout the research as a guiding framework. Data were analyzed using SPSS-PC (version 22.0 for MAC; SPSS, Chicago, IL) and MAXQDA (version11 for MAC; Berlin, Germany). Descriptive statistics performed included frequencies, mean scores, and Pearson correlation.
Results: Following the survey, mean scores of all Likert-scale questions targeting system use ranged from 2.26 to 6.11 based on a 9-point scale with an overall average of 5.28. No significant relationships were found among the subjects' age, job role, or amount of computer experience received and outcome measures. However, a moderate positive relationship was found between ease of training and user satisfaction (r = 0.437). Focus group data revealed four overarching themes: adopted workflows varied, few pediatric functions were embedded within the tool, interoperability with the EHR was poor to nonexistent, and staff were highly concerned about a breach to system security potentially leading to an adverse patient event.
Discussion/outcomes: By reevaluating usability issues throughout the implementation process, training and clinical workflow can be redesigned to assist pediatric providers in adopting secure messaging into their daily clinical process. Identification of future messaging capabilities, such as increased interoperability with the EHR, will be critical to ensure provider adoption and patient safety.
The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, and Department of Defense or the US Government.
Acknowledgment:
Special thanks to Jacqueline Moss, PhD, FAAN, RN; Terry Newton, MD; Michael Serwacki, MD; and Miko Watkins, MSN/MHA, RN-BC