Assessing workflow of emergency physicians in the use of clinical decision support

Salwei, Megan E.; Carayon, Pascale; Hoonakker, Peter; Hundt, Ann Schoofs; Novak, Clair; Wang, Yudi; Wiegmann, Douglas A.; Patterson, Brian W.

doi:10.1177/1071181319631334

Cited by 6 publications

(5 citation statements)

References 26 publications

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“…With MDCalc, physicians could decide not to follow the sequence of computing the Wells’ score first and then looking at PERC if appropriate. In a follow-up analysis,61 we found that study participants followed the recommended workflow almost always with PE-Dx (98%), and only half of the time with MDCalc (51%). PE-Dx was built to guide physicians in a clinical workflow that started with the Wells’ score and continued with the PERC rule; this led to a clear recommendation to either do nothing, order a D-dimer or order a CTA.…”

Section: Discussionmentioning

confidence: 89%

Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study

et al. 2019

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ObjectiveIn this study, we used human factors (HF) methods and principles to design a clinical decision support (CDS) that provides cognitive support to the pulmonary embolism (PE) diagnostic decision-making process in the emergency department. We hypothesised that the application of HF methods and principles will produce a more usable CDS that improves PE diagnostic decision-making, in particular decision about appropriate clinical pathway.Materials and methodsWe conducted a scenario-based simulation study to compare a HF-based CDS (the so-called CDS for PE diagnosis (PE-Dx CDS)) with a web-based CDS (MDCalc); 32 emergency physicians performed various tasks using both CDS. PE-Dx integrated HF design principles such as automating information acquisition and analysis, and minimising workload. We assessed all three dimensions of usability using both objective and subjective measures: effectiveness (eg, appropriate decision regarding the PE diagnostic pathway), efficiency (eg, time spent, perceived workload) and satisfaction (perceived usability of CDS).ResultsEmergency physicians made more appropriate diagnostic decisions (94% with PE-Dx; 84% with web-based CDS; p<0.01) and performed experimental tasks faster with the PE-Dx CDS (on average 96 s per scenario with PE-Dx; 117 s with web-based CDS; p<0.001). They also reported lower workload (p<0.001) and higher satisfaction (p<0.001) with PE-Dx.ConclusionsThis simulation study shows that HF methods and principles can improve usability of CDS and diagnostic decision-making. Aspects of the HF-based CDS that provided cognitive support to emergency physicians and improved diagnostic performance included automation of information acquisition (eg, auto-populating risk scoring algorithms), minimisation of workload and support of decision selection (eg, recommending a clinical pathway). These HF design principles can be applied to the design of other CDS technologies to improve diagnostic safety.

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Section: Discussionmentioning

confidence: 89%

Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study

et al. 2019

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“…Yet, one recent comprehensive study showed that vendors vary significantly in the quality of their UCD practices, ranging from well-developed UCD processes to fundamental misconceptions of the UCD process [ 8 ]. Several studies included in this synthesis addressed the value of following a user- or human-centered design approach broadly, either conducting UCD or HCD in their own work or noting the importance of these approaches in health informatics design [ 2 , 7 8 9 10 11 12 13 14 15 16 17 ]. However, for the reasons above, readers of HF/E-focused health informatics manuscripts should be careful to interpret the authors’ use of the (often confused) terms HCD and UCD, and not assume their design process is of high quality.…”

Section: Resultsmentioning

confidence: 99%

“…Many technologies focused on the creation and evaluation of customized clinical decision support tools. The application of these customized clinical decision support tools varied widely in context, including diagnostic support [ 17 , 132 ], antibiotic stewardship [ 36 , 70 ], screening for and management of chronic conditions [ 53 , 91 , 119 ], identifying individuals at risk for varied clinical outcomes [ 50 , 69 , 87 , 118 ].…”

Section: Resultsmentioning

confidence: 99%

Human Factors and Organizational Issues in Health Informatics: Innovations and Opportunities

Marquard

2021

Yearb Med Inform

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Objective: Human factors and ergonomics (HF/E) frameworks and methods are becoming embedded in the health informatics community. There is now broad recognition that health informatics tools must account for the diverse needs, characteristics, and abilities of end users, as well as their context of use. The objective of this review is to synthesize the current nature and scope of HF/E integration into the health informatics community. Methods: Because the focus of this synthesis is on understanding the current integration of the HF/E and health informatics research communities, we manually reviewed all manuscripts published in primary HF/E and health informatics journals during 2020. Results: HF/E-focused health informatics studies included in this synthesis focused heavily on EHR customizations, specifically clinical decision support customizations and customized data displays, and on mobile health innovations. While HF/E methods aimed to jointly improve end user safety, performance, and satisfaction, most HF/E-focused health informatics studies measured only end user satisfaction. Conclusion: HF/E-focused health informatics researchers need to identify and communicate methodological standards specific to health informatics, to better synthesize findings across resource intensive HF/E-focused health informatics studies. Important gaps in the HF/E design and evaluation process should be addressed in future work, including support for technology development platforms and training programs so that health informatics designers are as diverse as end users.

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“…Physicians' perceived risk of algorithms (e.g., the Wells' criteria) may also be leading to disuse. For instance, we previously identified situations in which physicians deviated from recommended clinical guidelines and prescribed algorithms due to the specific patient case (Salwei et al, 2019). Perceived risks (and disuse) may be minimized through increasing the transparency in the algorithms including the specific patient situations they apply to.…”

Section: Discussionmentioning

confidence: 99%

“…To support the complex PE diagnostic process, a multidisciplinary team designed a CDS, the PE diagnosis (Dx) CDS (Carayon et al, 2020; Hoonakker et al, 2019; Salwei et al, 2019). The human-centered design process included multiple HF methods: a work system analysis, iterative design sessions, focus groups, a heuristic evaluation, and usability testing (see Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Assessing workflow of emergency physicians in the use of clinical decision support

Cited by 6 publications

References 26 publications

Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study

Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study

Human Factors and Organizational Issues in Health Informatics: Innovations and Opportunities

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

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