Information system design for a hospital emergency department: A usability
analysis of software prototypes
Adem Karahoca a,*, Erkan Bayraktar a, Ekrem Tatoglu b, Dilek Karahoca a
a Faculty of Engineering, Bahcesehir University, Besiktas, Istanbul 34349, Turkey
b Faculty of Economics and Administrative Sciences, Bahcesehir University, Besiktas, Istanbul 34349, Turkey
a r t i c l e i n f o
Article history:
Received 14 January 2009
Available online 13 September 2009
Keywords:
Electronic health records
GUI design
Medical information systems
Human factors engineering
Usability engineering
Tablet PCs
a b s t r a c t
Study objective: The purpose of this study is to evaluate the usability of emergency department (ED) software
prototypes developed for Tablet personal computers (Tablet PCs) in order to keep electronic health
records (EHRs) of patients errorless and accessible through mobile technologies. In order to serve this
purpose, two alternative prototypes were developed for Tablet PCs: Mobile Emergency Department Software
(MEDS) and Mobile Emergency Department Software Iconic (MEDSI) among which the user might
choose the more appropriate one for ED operations based on a usability analysis involving the target
users.
Methods: The study is based on a case study of 32 potential users of our prototypes at the ED of Kadikoy-
AHG in Istanbul, Turkey. We examined usability of the prototypes for medical information systems by
means of Nielsen’s heuristic evaluation and cognitive walkthrough methods relying on 7-point scales,
and scenario completion success rate and average scenario completion time, respectively.
Results: The implementation of MEDSI in our case study confirmed the view that the usability evaluation
results of iconic GUIs were better than those of non-iconic GUIs in terms of Nielsen’s heuristic evaluation,
effectiveness and user satisfaction. For the whole sample, paired t-test scores indicated that there was a
significant difference (p < 0.01) between mean values of Nielsen’s usability scores toward MEDS and
MEDSI indicating that MEDSI was evaluated more favorably than MEDS. As for effectiveness of the prototypes,
significant differences (p < 0.01) were noted between MEDS and MEDSI in terms of both overall
scenario completion success rate and average scenario completion time. Similarly, for the full sample of
users independent sample t-test scores indicated that MEDSI was perceived significantly more favorable
(p < 0.01) than MEDS in terms of overall user satisfaction.
Conclusion: The study provides two important contributions to the extant literature. First, it addresses a
topic and methodology that serves potentially interesting to the biomedical informatics community.
Drawing on good background information and appropriate context, it involves various aspects of usability
testing. Another contribution of the study lies in its examination of two different prototypes during
the design phase involving the target users.
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