JMIR Publications

ABSTRACT

Background:

Major postoperative morbidity and mortality remain common despite efforts to improve patient outcomes. Health information technologies, such as decision support systems, have the potential to advance the standard of perioperative patient care. Failure to evaluate the usability of these technologies and barriers to their implementation can limit their acceptance within health systems.

Objective:

This manuscript describes the usability and acceptability of and systematic process for developing and adapting an innovative telemedicine based clinical support system, the Anesthesiology Control Tower. It also reports stakeholders’ perceptions of the barriers and facilitators the implementation of the intervention.

Methods:

Three phases of testing were conducted in an iterative manner in order to evaluate both the individual components of the Anesthesiology Control Tower and their integration as a whole. Phase 1 testing employed a “think-aloud” protocol analysis to identify surface level usability problems with individual software components of the ACT, in addition to the entirety of the structure. Phase 2 testing involved an extended qualitative and quantitative in-situ usability analysis. Phase 3 sought to identify major barriers and facilitators to implementation of the ACT through semi-structured interviews with key stakeholders.

Results:

Numerous usability problems with the software components of the ACT were identified in the Phase 1 and Phase 2 usability testing sessions. In response to these problems, seven iterations of the ACT software platform were developed. Initial satisfaction with the ACT, as measured by standardized measures, was below commonly accepted cutoffs for these measures. Satisfaction improved to acceptable levels over the course of revision and testing. A number of barriers to implementation were identified and addressed during the refinement of the ACT intervention.

Conclusions:

The Anesthesiology Control Tower system has the potential to improve the standard of perioperative anesthesia care. Through our thorough and iterative usability testing process and stakeholder assessment of barriers and facilitators, we were able to maximize the acceptability of this novel technology, thus improving our ability to implement this innovation into the model of care for perioperative medicine.