Usability of a Human Factors-based Clinical Decision Support in the Emergency Department: Lessons Learned for Design...

Area of Science:

• Medical Informatics
• Human Factors Engineering
• Emergency Medicine

Background:

• Clinical decision support (CDS) systems can enhance patient safety but face adoption challenges.
• A human-centered design process was used to develop a CDS tool for pulmonary embolism (PE) diagnosis in the emergency department (ED).
• The developed CDS demonstrated high usability during initial scenario-based testing.

Purpose of the Study:

• To evaluate the usability and actual use of a human factors (HF)-based CDS tool implemented in a real-world emergency department setting.
• To identify barriers affecting the adoption and utilization of the HF-based CDS among physicians.
• To gather physician feedback for future improvements of the CDS.

Main Methods:

• A survey was administered to emergency department (ED) physicians using a web-based platform (Qualtrics).
• The survey assessed the usability of the CDS by comparing scores from prior usability testing with real-world use.
• Physicians reported on their acceptance, usage patterns, perceived barriers, and suggestions for improvement regarding the CDS.

Main Results:

• Forty-seven physicians (56% response rate) completed the survey.
• Physicians recognized the diagnostic challenge of PE and the utility of risk scores.
• While usability was rated highly in both testing and clinical environments, actual CDS use was low, primarily due to a lack of workflow integration.

Conclusions:

• The design of CDS should be an iterative process, prioritizing usability within the broader clinical work system and physician workflow.
• Effective integration into existing workflows is crucial for the successful adoption and utilization of CDS tools in clinical practice.