JMIR Publications

ABSTRACT

Background:

Clinical decision support (CDS) has been shown to improve compliance with evidence-based care but its impact is often diminished due to issues such as poor usability, insufficient integration into workflow, and alert fatigue. Non-interruptive CDS may be less subject to alert fatigue but there has been little assessment of its usability.

Objective:

To assess the comparative usability of an interruptive versus non-interruptive version of a CDS

Methods:

We conducted a usability study of a CDS tool that recommended prescribing an angiotensin converting enzyme (ACE) inhibitor for inpatients with heart failure. We developed two versions of the CDS: an interruptive alert triggered at order entry and a non-interruptive alert listed in the sidebar of the electronic health record (EHR) screen. Inpatient providers were recruited and randomly assigned to use the interruptive followed by non-interruptive alert or vice versa in a laboratory setting. We asked providers to “think aloud” while using the CDS and then conducted a brief semi-structured interview about usability. We used a constant comparative analysis informed by the Five Rights of CDS framework to analyze usability testing.

Results:

Twelve providers participated in usability testing. Providers noted that the interruptive alert was readily noticed but generally impeded workflow. The non-interruptive alert was felt to be less annoying but had lower visibility which might reduce engagement. Provider role seemed to influence preferences; for instance, some providers who had more global responsibility for patients seemed to prefer the non-interruptive alert while more task-oriented providers generally preferred the interruptive alert.

Conclusions:

Providers expressed tradeoffs between impeding workflow and improving visibility with interruptive and non-interruptive versions of a CDS. Two potential approaches to effective CDS may include targeting alerts by provider role or supplementing a non-interruptive alert with an occasional, well-timed interruptive alert.