Usability barriers and facilitators of a human factors engineering-based clinical decision support technology for diagnosing pulmonary embolism

Int J Med Inform. 2021 Dec 9;158:104657. doi: 10.1016/j.ijmedinf.2021.104657. Online ahead of print.


Background: Health IT, such as clinical decision support (CDS), has the potential to improve patient safety. However, poor usability of health IT continues to be a major concern. Human factors engineering (HFE) approaches are recommended to improve the usability of health IT. Limited evidence exists on the actual impact of HFE methods and principles on the usability of health IT.

Objective: To identify and describe the usability barriers and facilitators of an HFE-based CDS prior to implementation in the emergency department (ED).

Methods: We conducted debrief interviews with 32 emergency medicine physicians as a part of a scenario-based simulation study evaluating the usability of the HFE-based CDS. We performed a deductive content analysis of the interviews using the usability criteria of Scapin and Bastien as a framework.

Results: We identified 271 occurrences of usability barriers (94) and facilitators (177) of the HFE-based CDS. For instance, we found a facilitator relating to the usability criteria prompting as the PE Dx helps the physician order diagnostic tests following the risk assessment. We found the most facilitators relating to the criteria, minimal actions, e.g. as the PE Dx automatically populates vitals signs (e.g., heart rate) from the chart into the CDS. The majority of the usability barriers related to the usability criteria, compatibility (i.e., workflow integration), which was not explicitly considered in the HFE design of the CDS. For example, the CDS did not support resident and attending physician teamwork in the PE diagnostic process.

Conclusion: The systematic use of HFE principles in the design of CDS improves the usability of these technologies. In order to further reduce usability barriers, workflow integration should be explicitly considered in the design of health IT.

Keywords: Clinical decision support; Emergency medicine; Human factors engineering; Usability evaluation; Workflow integration.