Ensuring the safety of health information systems: using heuristics for patient safety

Health information systems (HISs) are typically seen as a mechanism for reducing medical errors. However, there is evidence to suggest that technology can facilitate or induce medical errors. Therefore, it is crucial that we fully test systems prior to their implementation in real-world settings. Presently, evidence-based evaluation heuristics that are specific to HISs do not exist for assessing aspects of interface design that may facilitate errors. A three-phase study was conducted to determine the utility of evidence-based heuristics in evaluating a human-technology interface (i.e., the Veterans Affairs Computerized Patient Record System [VA CPRS]). Phase one consisted of a systematic review of the health informatics literature involving technology-facilitated or technology-induced error. Phase two involved reviewing the literature and generating a comprehensive list of 38 heuristics that could be used to evaluate an HIS for technology-induced errors. Lastly, phase three involved conducting a heuristic evaluation of the VA CPRS system using evidence-based heuristics. Results from this work are discussed.