User-Centered Redesign of a Clinical Decision Support System for Pneumonia in the Emergency Department

Deviation from evidence-based guidelines is common and associated with worse patient outcomes, especially in hectic emergency departments (EDs). Clinical decision support (CDS) systems can improve outcomes by promoting guideline adherence while allowing patient-specific adaptation. Implementation of a CDS system for pneumonia ("ePneumonia") in the ED has been associated with improved guideline adherence and reduced 30-day mortality. However, adoption of ePneumonia has been hindered by a suboptimal user interface (UI).This study aimed to redesign the ePneumonia UI to improve usability and adoption.We conducted a user-centered design study involving ED clinicians at Vanderbilt University Medical Center. Across two rounds of one-on-one usability interviews with ED clinicians held via videoconference we (1) identified user requirements, and (2) iteratively refined a UI prototype. During each usability interview we presented realistic pneumonia cases, observed the clinician interact with a prototype, and elicited feedback with a semi-structured interview guide. We applied rapid thematic analysis and iteratively updated ePneumonia UI prototypes between interviews.Among 21 invited ED clinicians, 19 (90%) participated, including 15 attendings, 3 residents, and 1 advanced practice provider; 6 (32%) participants were women. Initial findings revealed that the original step-by-step UI did not align with the dynamic ED workflow. Clinicians expressed a need for both flexibility (e.g., skipping sections, overriding recommendations) and constraints (e.g., alerts for guideline deviations). We identified UI features to meet these needs that resulted in greater subjective usability including: a three-step navigation scheme, tiered information display, and multimodal indicators (text, icon, color) of agreement between clinician choices and CDS recommendations.A user-centered design approach identified UI features that were associated with greater perceived usability of a CDS for pneumonia in the ED. Future work will evaluate real-world usability and adoption in a clinical trial.