Companies developing and commercializing Healthcare IT applications may decide to involve the users in the software development lifecycle in order to better understand the users' needs and to optimize their products. Unfortunately direct developers-users dialogues are not sufficient to ensure a proper understanding of the users' needs. It is also necessary to involve human factors specialists to analyze the users' expression of their needs and to properly formalize the requirements for design purposes. The objective of this paper is to present a case study reporting the collaborative work between HF experts and a company developing and commercializing a CPOE. This study shows how this collaboration helps resolve the limits of direct users involvement and usual problems pertaining to users' needs description and understanding.
Method: The company participating in the study has implemented a procedure to convene regular meetings allowing direct exchanges between the development team and users' representatives. Those meetings aim at getting users' feedbacks on the existing products and at validating further developments. In parallel with usual HF methods supporting the analysis of the work system (onsite observations followed by debriefing interviews) and the usability evaluation of the application (usability inspection and usability tests), HF experts took the opportunity of the meetings organized by the company to collect, re-interpret and re-formulate the needs expressed by the users.
Results: The developers perceive the physicians' requirements concerning the display of the patient's list of medication as contradictory. In a previous meeting round the users had required a detailed view of the medication list against the synthesized existing one. Once this requirement satisfied, the users participating in the current meeting round require a synthesized view against the existing detailed one. The development team is unable to understand what they perceive as a reverse claim. Relying on a cognitive analysis of the physicians' decision making concerning the patient's treatment, the HF experts help re-formulate the physicians' cognitive needs in terms of synthesized/detailed display of the medication list depending on the stage of the decision making process. This led to an astute re-engineering of the application allowing the physicians to easily navigate back and forth between the synthesized and detailed views depending on the progress of their decision making.
Conclusion: This study demonstrates that the integration of users' representatives in the software lifecycle is a good point for the end users. But it remains insufficient to resolve the complex usability problems of the system. Such solutions require the integration of HF expertise. Moreover, such an involvement of HF experts may generate benefits in terms of reduction of (i) the number of iterative developments and (ii) the users' training costs.
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