Bell Eapen MD, PhD.

evaluation of eyetracking after an usability test (Photo credit: Wikipedia)

Health information exchange (HIE) allows healthcare providers and patients to access and securely share medical information electronically. Several organizations are now emerging to provide both form and function for HIE efforts, both on independent and governmental/regional levels. However the biggest challenge is Change Management, as healthcare providers are exposed to one more ICT tool that they need to master for providing quality care.

There are no formal tools to study individual and organizational attitude towards HIE or to measure their usability. Physician attitude towards the impact of HIE on reducing healthcare costs, improving quality of patient care, saving time and their concern about data privacy and security are important in HIE adoption. Usability is also of vital importance in the meaningful use of HIE tools.

SUSie (SUS for HIE) is an attempt at creating a useful tool for measuring the above factors. It is modelled based on System Usability Scale (SUS), one of the most used questionnaire for measuring perceptions of usability. Five additional questions were added to assess factors that are specific for HIE. The scoring is based on a scale of 5 ranging from Strongly disagree(1) to Strongly agree (5). The ratio of positively and negatively worded questions are maintained and the final multiplication factor was changed to 1.67 to represent the final score on a scale of 100. I hope that this would make the interpretation similar to SUS and benefit from the prior experience available for SUS. The questions and details of scoring are explained below.

If you use SUSie, please cite this webpage and the articles below:

• Brooke, J. (1996). “SUS: a “quick and dirty” usability scale”. In P. W. Jordan, B. Thomas, B. A. Weerdmeester, & A. L. McClelland. Usability Evaluation in Industry. London: Taylor and Francis.
• Wright, Adam et al. “Physician attitudes toward health information exchange: results of a statewide survey.” Journal of the American Medical Informatics Association 17.1 (2010): 66-70.
• Eapen BR (2014). “SUSie: SUS based questionnaire for assessing usability and provider attitude toward health information exchange.” Applied Bimatics – An Informatics & eHealth Blog.[Internet] Accessible from: http://bioblog.gulfdoctor.net/2014/06/susie-hie-usability-physician-attitude.html

Questions:

1. I think that I would like to use this Health Information Exchange System frequently. 
2. I found this Health Information Exchange System unnecessarily complex. 
3. I think this Health Information Exchange System will reduce healthcare costs. 
4. I think that I would need the support of a technical person to be able to use this Health Information Exchange System. 
5. I thought this Health Information Exchange System was easy to use. 
6. I thought there was too much inconsistency in this Health Information Exchange System. 
7. I think this Health Information Exchange System will improve Quality of Patient Care. 
8. I found this Health Information Exchange System very cumbersome to use. 
9. I found the various functions in this Health Information Exchange System were well integrated. 
10. I am concerned about the privacy and security of healthcare information on this Health Information Exchange System. 
11. I found this Health Information Exchange System can save me time. 
12. I needed to learn a lot of things before I could get going with this Health Information Exchange System. 
13. I would imagine that most people would learn to use this Health Information Exchange System very quickly. 
14. I found that I had to significantly change my workflow to use this Health Information Exchange System.
15. I felt very confident using this Health Information Exchange System.

SUSie uses the following response format:

Scoring SUSie

• For odd items: subtract one from the user response.
• For even-numbered items: subtract the user responses from 5
• This scales all values from 0 to 4 (with four being the most positive response).
• Add up the converted responses for each user and multiply that total by 1.67. 
• This converts the range of possible values from 0 to 100 instead of from 0 to 60.

Interpreting SUSie (Based on SUS)

• The value is not a percentage.
• Average value is approximately 68.
• This is not a validated questionnaire.
• A percentile graph for SUS and other relevant information is available here: http://www.measuringusability.com/sus.php (courtesy: Jeff Sauro )
• SUSie may be used to compare groups or for comparing pre and post intervention.

I have created a wiki page for updates. Please add any use-cases you can think of to the Wiki page.