Despite expanding use and tremendous promise, healthcare information technologies are plagued with two major barriers: difficulty leveraging complex health record data to improve care and poor usability. Using a wide variety of methods, my informatics research focuses on overcoming both barriers, with the ultimate goal of improving patient outcomes.
My most recent publications use the systematic and integrative review method. To date, technologies designed to support nurses’ decision making have lagged behind medical research of decision aids in quality, volume and level of evidence. Recently, as lead author of the first integrative review of decision aids for hospital nurses, we found that decision aids for nurses improve patient outcomes, healthcare processes and have high usability. Additional funding is needed in this area so that larger and more rigorous designs can be applied to this promising approach for improving healthcare quality.
As senior author of an accepted systematic review of usability measures, we identified 15 developed usability questionnaires, but found only 5 that were generalizable enough to be used across technologies. We also found that no questionnaires measured all 5 major usability attributes (Learnability, Memorability, Efficiency, User Satisfaction and Error Rate and Recovery), but believe combinations of high quality currently developed questionnaires can be used to measure all 5 usability attributes. This publication will provide needed guidance and encouragement to researchers and developers of healthcare technologies to carefully choose appropriate and strong usability measures.
I have also conducted mixed methods studies, grounded in human factors approaches, of information technologies in clinical work settings. These studies have revealed benefits, unintended consequences, and the need for new designs to improve care effectiveness and reduce potential errors. My team was the first to look beyond patient factors and nursing knowledge deficits to study the most common hospital adverse event: patient falls. Our results identified limitations in the physical work environment, alarms and workflow that impede nurses’ abilities to prevent falls. Our results can be used to redesign work, work environments and fall prevention technologies.
I have also conducted a qualitative analysis of nurses’ information flow within a larger federally funded study. The findings revealed variations in nursing documentation that led to risks of errors and adverse events. Building on these findings, I have an ongoing work-setting study that focuses on the usability and cognitive workload associated with new electronic health record systems over time. Our preliminary results show that problems with sub-optimal usability and increased workload persist for more than two years after health record implementation. This provides evidence that poor usability is not a transient problem and underscores the need for additional research to improve electronic health records usability.
I have also conducted a mixed method pilot study of communication technology to support nurse-physician communication on medical surgical units. Three major themes emerged during our preliminary analysis: 1) Electronic health records are used for the lion’s share of interdisciplinary communication, but does not facilitate collaboration, 2) Alpha- text paging facilitates resident’s situation awareness and care planning efficiency and 3) Outdated communication technologies, poor usability and misguided communication policies can cause communication failures that put patients at risk.
Finally, I led the Usability Team in a National Institute of Nursing Research funded study that use electronic health record "big data" to develop clinical decision support for nurses who care for patients near end of life. Together with engineering collaborators in data mining and data visualization, we used user-center design methods to develop and improve the usability and usefulness of electronic electronic health record clinical decision aid prototypes. We conducted this research using simulation so that the technology can be well evaluated before implementation in practice. We also conducted a pilot randomized clinical trial in a virtual environment (CAVE) that simulated a hospital nursing unit. Plans for a full powered randomized clinical trial in a simulated setting are underway.
- Quality, Safety and Health Information Technology
- Developing Literature Reviews
Selected Service Includes:
- Ad hoc Grant Reviewer: National Science Foundation, Smart and Connected Health & National Institute of Health, Small Business Innovation Research
- Member: Information Technology Governance Council Research Committee, University of Illinois at Chicago
- Primary Mentor: Postdoctoral Fellow funded by The Brazilian National Council for Scientific and Technological Development
- Primary Mentor: Undergraduate Student Behavioral and Biomedical Sciences Bridges to Baccalaureate Program
Junior Researcher Award, Health Systems, Policy, and Informatics. Research Interest Group, Midwest Nursing Research Society
Funding: Office of the Vice Chancellor for Research, Campus Research Board. Benefits and unintended consequences of communication technology use in hospitals.
Co-Chair Elect Research Interest Group: Health Systems, Policy, & Informatics (2016-19)
Dunn Lopez, K, Gephart, S, Raszewski, R, Sousa, V, Price, L & Abraham, J. (2016).Integrative review of clinical decision support for registered nurses in acute care settings. Journal of the American Medical Informatics Association. DOI: https://doi.org/10.1177/0193945916678212
Dunn Lopez, K, Febretti, A, Stifter, J, Johnson, A, Wilkie, DJ, & Keenan, G. (2016).Toward a more robust & efficient usability testing method of clinical decision support for nurses derived from nursing electronic health record data. International Journal for Nursing Knowledge. DOI: 10.1111/2047-3095.12146
Dunn Lopez, K, Wilkie, DJ, Yao, Y, Sousa, V, Febretti, A, Stifter, J, Johnson, A, & Keenan, G. (2016). Nurses’ numeracy and graphical literacy: informing studies of clinical decision support interfaces. (2016). Journal of Nursing Care Quality. 31(2), 124-130. DOI: 10.1097/NCQ. 00000 00000000149
Sousa VEC, Matson J, Dunn Lopez K. (2016) Questionnaire Adapting: Little Changes Mean a Lot. Western Journal of Nursing Research. DOI: https://doi.org/10.1177/0193945916678212
Abraham, J, Kannampallil, T, Brenner, C, Lopez, K D, Almoosa, KF, Patel, B, & Patel, VL. (2016). Characterizing the structure and content of nurse handoffs: A sequential conversational analysis approach. Journal Biomedical Informatics, 59, 76-88
Morrow, DG & Dunn Lopez, K. (2015). Theoretical foundations for health communication research and practice. In Patel, VL, Kannampalil, T, & Kaufman, DR (Eds.). Cognitive Informatics in Health and Biomedicine: Human Computer Interaction in Healthcare. New York, NY: Springer
Sousa, VEC, Dunn Lopez, K, Febretti, A, Stifter, J, Yao, Y, Johnson, A, Wilkie, DJ, & Keenan, G. (2015). Use of simulation to study nurses acceptance and non-acceptance of clinical decision support suggestions. Computers Informatics Nursing, 33(10), 465-472.
Stifter, J, Yao, Y, Lodhi, M K, Lopez, K D, Khokhar, A, Wilkie, D, & Keenan, GM (2015). Nurse continuity and hospital-acquired pressure ulcers: A comparative analysis using an electronic health record “Big Data” set. Nursing Research, 64(5), 361-371
Keenan, GM, Yakel, E, Dunn Lopez, K, Tschannen, D, & Ford, YB (2013). Challenges to nurses’ efforts of retrieving, documenting and communicating patient care. Journal of the American Medical Informatics Association 20(2), 245-252
Yao, Y, Keenan, G, Xu, D, Khokhar, A, Al-Masalha, F, Dunn Lopez, K, Ansari, R, & Wilkie, DJ. (2013). Current state of pain care for hospitalized patients at end of life. American Journal of Hospice and Palliative Medicine, 30(2), 128-136
Dunn Lopez, K, Kanak, MF, Cary, MP, Gerling, G. (2010). Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting. Journal of the American Medical Informatics Association 17(3), 313-321.
- Describing, contrasting and visualizing end of life care in the 21st century.
- Benefits and unintended consequences of communication technology use in hospitals.
- Evaluating the impact of “meaningful use” electronic health record system implementation on outpatient clinic processes.