Ensuring Usability through Human Factors Engineering

Although the advantages and shortcomings of an AIMS have been debated, in the age of advanced computers, it seems arcane to manually transcribe to a paper form numbers that are displayed on a patient monitor. Potential human errors associated with manual systems include failing to record data due to distraction or forgetfulness, misreading data, and transcribing data incorrectly or illegibly (Fig. 5.1 ). Entering data into forms is a task that computers perform particularly well, whereas humans are prone to error. In recognition of this reality, the Anesthesia Patient Safety Foundation passed the following motion in 2001: “The APSF endorses and advocates the use of automated record keeping in the perioperative period and the subsequent retrieval and analysis of the data to improve patient safety.”¹ Nonetheless, most anesthesia providers continue to document their cases using paper forms more than 20 years after the introduction of the first automated systems. ² Sometimes, the choice is a matter of economics, with AIMS costs estimated to be $20,000 per OR. Sometimes, clinicians are concerned that automation can decrease their situational awareness during a case. Given how an anesthesia record can factor into medical malpractice proceedings, some clinicians are also concerned about the ease of detecting and accounting for artifacts (e.g., aberrant data) with an AIMS. However, the usability shortcomings of AIMS$#x2014;many related to design of the software user interface—have historically represented a major obstacle to wider adoption.

Fortunately, the latest generation of AIMS has overcome many of the human factors shortcomings found in earlier systems and includes upgrades such as graphical user interfaces and touchscreens, making them far more usable (Fig. 5.2 ). Nonetheless, opportunities remain for enhancing their usability. The human factors challenges associated with producing a usable AIMS, as well as broader issues of user acceptance related to AIMS’s usefulness, efficiency, and appeal are discussed in this chapter.