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医嘱录入系统人机交互绩效研究
其他题名Research on Human Computer InteractionPerformanceof Computerized Physician Order Entry System
吴雪
学位类型博士
导师张侃 ; 吴昌旭
2016-10
学位授予单位中国科学院研究生院
学位授予地点北京
学位专业心理学
关键词医嘱录入系统 风险感知 任务复杂度 时间压力 数字键盘
摘要患者安全是医疗领域的永恒课题。近年来,随着医院信息系统(Hospital information system,HIS)的快速发展,医嘱电子化水平不断提高,医生开立医嘱的过程由传统纸质手写医嘱转变为在医嘱录入系统(Computerizedphysician order entrysystem, CPOE)中录入医嘱,人与计算机的交互产生了与传统纸质手写医嘱不同的错误类型。本研究基于人机交互(Human computer interaction, HCI)视角,分别从人因、计算机角度分析风险感知、任务复杂度、时间压力、数字键盘布局和按键特征4个因素对CPOE交互绩效的影响,最终目的是预防和减少医嘱错误(Precribing error),保障患者安全。
本研究将工程心理学、管理心理学研究方法运用到CPOE交互绩效的研究中,通过访谈、观察、问卷调查探究医生对CPOE医嘱错误的风险感知水平及原因分析;通过改良的专家咨询法(Delphi法)对CPOE交互任务复杂程度进行量化;通过情境模拟(Scenario)和实验室模拟实验研究范式,探明风险感知、任务复杂度和时间压力对CPOE交互绩效的影响;通过实验室模拟实验研究范式,探明不同数字键盘及0~9按键特征对CPOE数字交互绩效的影响,并通过数据挖掘(Data mining),分析CPOE数字错误的类型。研究结果显示:
(1)医生对CPOE医嘱错误的风险感知水平有待提高,其认为导致错误的20种原因聚合为任务、硬件、环境、界面、操作习惯5大类。
(2)CPOE交互任务复杂度得分略高于核电应急操作规程交互任务,不同医嘱任务复杂度变异程度较低。
(3)任务复杂度和时间压力对错误率存在显著交互效应,缓解时间压力可减少高任务复杂度导致的错误率上升。
(4)风险感知、任务复杂度和时间压力对错误率和完成时间存在显著的三阶交互效应。对高风险感知组,任务复杂度和时间压力存在显著交互效应,即缓解时间压力可减少高任务复杂度导致的错误率上升,延长高任务复杂度导致的完成时间增加;对低风险感知组,任务复杂度和时间压力交互效应不显著。
(5)数字键盘和时间压力对CPOE数字错误率和完成时间存在显著交互效应。时间压力下,主键盘数字横行错误率高,完成时间长。
(6)小数字键盘0~9按键中,“0”、“2”按键错误率显著低于其他按键,“3” 按键完成时间显著长于其他按键,按键与母键(主键盘H键)的距离与完成时间呈高度正相关,但与错误率不存在相关关系。
(7)主键盘数字横行0~9按键中,“5”、“6”按键错误率显著低于其他按键,“3”按键完成时间显著长于其他按键。按键与母键(主键盘H键)的距离与错误率、完成时间呈高度正相关。
(8)小数字键盘与主键盘数字横行错误类型存在显著差异。小数字键盘换位错误比例高,主键盘数字横行遗漏错误比例高。除“3”、“9”按键外,其他各按键不同错误类型的错误率存在显著差异。
本研究不仅丰富了以往风险感知、任务复杂度和时间压力变量操纵的研究结果,将这些概念拓展到CPOE交互绩效的研究中,而且探明其对CPOE交互绩效影响的实证证据,为政府部门、医疗机构制定措施提高医生风险感知水平、降低时间压力提供依据,也为CPOE研发机构改进系统设计提供数据支持,对减少医嘱错误、保障患者安全具有现实意义。
其他摘要Patient safety is an eternal subject in the medical field. In recent years, with the rapid development of hospital information system(HIS), and continuously improvement of the computerized physician order entry system(CPOE), doctors’ prescription has been changed from traditional paper-based handwritten orders into computerized order entry. This new entry task produced different error types. This research is based on human computer interaction (HCI), from the perspective of human factors and computer tasks, to analyse the effects of risk perception, task complexity, time pressure, and keyboard layout on the performance of the order entryperformance. The ultimate goal is to prevent and reduce medicalerrors, and to ensure the safety of the patients.
In this study, research methods of engineering psychology and management psychology wereapplied to the study of CPOE operationperformance. Risk perception level of medical staff and cause of prescribing errors were investigated through interviews, observation and questionnaire survey. Task complexity of the order entry were evaluated through the improved expert consultation method (Delphi method). The interaction effect of risk perception, task complexity and time pressure on order entry performance were explored through scenario and laboratory experiment research paradigm. Furthermore, the effect of keyboard layout and keystroke features of digit 0~9 onnumeric entry performance were verified through laboratory experiment research paradigm, and the numeric entry error analysis was performed through Data mining. Results showedthat:
(1) Risk perception level of the medical staff on order entry error should be improved. They attributed the precribingerror to twenty reasons categorized into five domains, including task, hardware, environment, interface design, and operating habits.
(2) Task complexityscore of CPOEwasslightly higher than that of the nuclear emergency operating task. The task complexity score had low degree of variation.
(3) There were significant interaction effects of task complexity and time pressure on error rate. In the high complexity task,relievedtime pressure can reduce error rate.
(4)There were significant interaction effects of risk perception, task complexity and time pressureon error rateandcompletion time. For the high risk perception group, task complexity and time pressure had significant interaction effect, in which the relieved time pressure can reduce the effect of task complexity on error rate,and extend the effect of task complexity on completion time. For the low risk perception group, task complexity and time pressure had no significant interaction effect.
(5) There were significant interaction effects of keyboard layout and time pressure on numericerror rateand completion time. With time pressure, main keyboard digital line had significantly higher error rateand longer completion time.
(6) Significant difference existed in error rate and completion time of different digital keys in Numpad. Error rate of key “0” and “2” was significantly lower than that of otherkeys. Completion time ofkey "3" was significantly longerthan that of other keys. The distance of the keywith the parent key (key “H” in the main keyboard) was significantly positive correlated with completion time. But there was no significant correlation between distance and error rate.
(7) Significant difference existed in error rate and completion time of different digital keys in the main keyboard digital line. Error rate of key “5” and “6” was significantly lower than that of other keys. Completion time of key "3" was significantly higher than that of other keys. The distance of the keywith the parent key (key “H” in the main keyboard) was significantly positive correlated with completion time and error rate.
(8) Significant difference existed in error types of Numpad and main keyboard digital line. The transposition error ratio of Numpad was higher than that of the main keyboard digital line. The omission error ratio of the main keyboard digital linewas higher than that of Numpad. Additionally, significant difference existed in error types of each key between the main keyboard digital line and Numpad,with the exception of key “3” and “9”.
This study not only enriches the previous study on risk perception, task complexity and time pressure, but also expands these psychological concepts into medical field and evaluates the effects on order entry performance. The results of the study provide research data to support the government departments, medical institutions and CPOE manufacturers to improve system design and risk perceptionof the staff, reduce task complexity and time pressure, and ultimately to decreaseprecribingerrors and improve patient safety.
学科领域应用心理学
语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/20838
专题社会与工程心理学研究室
作者单位中国科学院心理研究所
推荐引用方式
GB/T 7714
吴雪. 医嘱录入系统人机交互绩效研究[D]. 北京. 中国科学院研究生院,2016.
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