Usability Evaluation of Visual Representation Formats for Emergency Department Records

Background Integration of electronic information is a challenge for multitasking emergency providers, with implications for patient safety. Visual representations can assist sense-making of complex data sets; however, benefit and acceptability in emergency care is unproven. Objectives This article evaluates visually focused alternatives to lists or tabular formats, to better understand possible usability in Emergency Department Information System (EDIS). Methods A counterbalanced, repeated-measures experiment, satisfaction surveys, and narrative content analysis was conducted remotely by Web platform. Participants were 37 American emergency physicians; they completed 16 clinical cases comparing 4 visual designs to the control formats from a commercially available EDIS. They then evaluated two additional chart overview representations without controls. Results Visual designs provided benefit in several areas compared to controls. Task correctness (90% to 76%; p = 0.003) and completion time (median: 49-74 seconds; p < 0.001) were superior for a medication history timeline with class and schedule highlighting. Completion time (median: 45-60 seconds; p = 0.03) was superior for a past medical history design, using pertinent diagnosis codes in highlighting rules. Less mental effort was reported for visual allergy (p = 0.04), past medical history (p < 0.001), and medication timeline (p < 0.001) designs. Most of the participants agreed with statements of likeability, preference, and benefit for visual designs; nonetheless, contrary opinions were seen, and more complex designs were viewed less favorably. Conclusion Physician performance with visual representations of clinical data can in some cases exceed standard formats, even in absence of training. Highlighting of priority clinical categories was rated easier-to-use on average than unhighlighted controls. Perceived complexity of timeline representations can limit desirability for a subset of users, despite potential benefit.