|Alternative Title||Research on Human Computer InteractionPerformanceof Computerized Physician Order Entry System|
|Thesis Advisor||张侃 ; 吴昌旭|
|Place of Conferral||北京|
|Keyword||医嘱录入系统 风险感知 任务复杂度 时间压力 数字键盘|
|Abstract||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。|
|Other Abstract||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.
|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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