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

doi:10.1177/00187208221078625

. 2024 Mar;66(3):647-657.

doi: 10.1177/00187208221078625. Epub 2022 Apr 14.

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

Megan E Salwei¹, Peter Hoonakker², Pascale Carayon³, Douglas Wiegmann³, Michael Pulia^{4

5}, Brian W Patterson⁶

Affiliations

¹ Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
² Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
³ Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
⁴ Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
⁵ BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.
⁶ Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.

PMID: 35420923
PMCID: PMC9581441 (available on 2025-03-01)
DOI: 10.1177/00187208221078625

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

Megan E Salwei et al. Hum Factors. 2024 Mar.

. 2024 Mar;66(3):647-657.

doi: 10.1177/00187208221078625. Epub 2022 Apr 14.

Authors

Megan E Salwei¹, Peter Hoonakker², Pascale Carayon³, Douglas Wiegmann³, Michael Pulia^{4

5}, Brian W Patterson⁶

Affiliations

¹ Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
² Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
³ Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
⁴ Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
⁵ BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.
⁶ Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.

PMID: 35420923
PMCID: PMC9581441 (available on 2025-03-01)
DOI: 10.1177/00187208221078625

Abstract

Objective: To evaluate the usability and use of human factors (HF)-based clinical decision support (CDS) implemented in the emergency department (ED).

Background: Clinical decision support can improve patient safety; however, the acceptance and use of CDS has faced challenges. Following a human-centered design process, we designed a CDS to support pulmonary embolism (PE) diagnosis in the ED. We demonstrated high usability of the CDS during scenario-based usability testing. We implemented the HF-based CDS in one ED in December 2018.

Method: We conducted a survey of ED physicians to evaluate the usability and use of the HF-based CDS. We distributed the survey via Qualtrics, a web-based survey platform. We compared the computer system usability questionnaire scores of the CDS between those collected in the usability testing to use of the CDS in the real environment. We asked physicians about their acceptance and use of the CDS, barriers to using the CDS, and areas for improvement.

Results: Forty-seven physicians (56%) completed the survey. Physicians agreed that diagnosing PE is a major problem and risk scores can support the PE diagnostic process. Usability of the CDS was reported as high, both in the experimental setting and the real clinical setting. However, use of the CDS was low. We identified several barriers to the CDS use in the clinical environment, in particular a lack of workflow integration.

Conclusion: Design of CDS should be a continuous process and focus on the technology's usability in the context of the broad work system and clinician workflow.

Keywords: Health information technology; implementation; sociotechnical systems; usability; workflow integration.

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References

1. Bennett P, & Hardiker NR (2016). The use of computerized clinical decision support systems in emergency care: a substantive review of the literature. Journal of the American Medical Informatics Association, 24(3), 655–668. - PMC - PubMed
1. Carayon P. (2006). Human factors of complex sociotechnical systems. Applied Ergonomics, 37(4), 525–535. - PubMed
1. Carayon P, Cartmill R, Blosky MA, Brown R, Hackenberg M, Hoonakker P, . . . Walker (2011). ICU nurses’ acceptance of electronic health records. Journal of the American Medical Informatics Association, 18(6), 812–829. doi:10.1136/amiajnl-2010-000018 - DOI - PMC - PubMed
1. Carayon P, Hoonakker P, Hundt AS, Salwei ME, Wiegmann D, Brown RL, . . . Wang Y. (2020). Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study. BMJ Quality & Safety, 29(4), 329–340. - PMC - PubMed
1. Carayon P, Hundt AS, Karsh B-T, Gurses AP, Alvarado CJ, Smith M, & Brennan PF (2006). Work system design for patient safety: The SEIPS model. Quality & Safety in Health Care, 15(Supplement I), i50–i58. - PMC - PubMed

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[1] Bennett P, & Hardiker NR (2016). The use of computerized clinical decision support systems in emergency care: a substantive review of the literature. Journal of the American Medical Informatics Association, 24(3), 655–668. - PMC - PubMed

[2] Bennett P, & Hardiker NR (2016). The use of computerized clinical decision support systems in emergency care: a substantive review of the literature. Journal of the American Medical Informatics Association, 24(3), 655–668. - PMC - PubMed

[3] Carayon P. (2006). Human factors of complex sociotechnical systems. Applied Ergonomics, 37(4), 525–535. - PubMed

[4] Carayon P. (2006). Human factors of complex sociotechnical systems. Applied Ergonomics, 37(4), 525–535. - PubMed

[5] Carayon P, Cartmill R, Blosky MA, Brown R, Hackenberg M, Hoonakker P, . . . Walker (2011). ICU nurses’ acceptance of electronic health records. Journal of the American Medical Informatics Association, 18(6), 812–829. doi:10.1136/amiajnl-2010-000018 - DOI - PMC - PubMed

[6] Carayon P, Cartmill R, Blosky MA, Brown R, Hackenberg M, Hoonakker P, . . . Walker (2011). ICU nurses’ acceptance of electronic health records. Journal of the American Medical Informatics Association, 18(6), 812–829. doi:10.1136/amiajnl-2010-000018 - DOI - PMC - PubMed

[7] Carayon P, Hoonakker P, Hundt AS, Salwei ME, Wiegmann D, Brown RL, . . . Wang Y. (2020). Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study. BMJ Quality & Safety, 29(4), 329–340. - PMC - PubMed

[8] Carayon P, Hoonakker P, Hundt AS, Salwei ME, Wiegmann D, Brown RL, . . . Wang Y. (2020). Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study. BMJ Quality & Safety, 29(4), 329–340. - PMC - PubMed

[9] Carayon P, Hundt AS, Karsh B-T, Gurses AP, Alvarado CJ, Smith M, & Brennan PF (2006). Work system design for patient safety: The SEIPS model. Quality & Safety in Health Care, 15(Supplement I), i50–i58. - PMC - PubMed

[10] Carayon P, Hundt AS, Karsh B-T, Gurses AP, Alvarado CJ, Smith M, & Brennan PF (2006). Work system design for patient safety: The SEIPS model. Quality & Safety in Health Care, 15(Supplement I), i50–i58. - PMC - PubMed

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

Affiliations

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

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Abstract

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