Usability of a Human Factors Engineering–Based Clinical Decision Support Technology

Health information technology (IT)—such as a pulmonary embolism (PE) diagnosis clinical decision support (CDS)—could improve patient safety. However, poor usability continues to be a major concern, according to a study published in the International Journal of Medical Informatics. Human factors engineering (HFE) approaches have been recommended to improve health IT usability, but few studies have actually investigated the effects of HFE principles. As such, Megan E Salwei, PhD, and collaborators, sought to identify barriers and facilitators to use of PE diagnosis CDS prior to implementation in an emergency department (ED), and judged that the “systematic use of HFE principles in the design of CDS improves the usability of these technologies.”

To further reduce barriers to usability, “workflow integration should be explicitly considered in the design of health IT,” Dr. Salwei advised. “The Scapin and Bastien usability criteria can support consideration of workflow integration during a technology’s design,” she added.

The researchers held debrief interviews with 32 ED physicians to evaluate the usability of the HFE–based CDS. With the usability criteria of Scapin and Bastien as a framework, they also performed a deductive analysis of the content of the interviews.

The team identified 94 barriers and 177 facilitators to usability of a CDS for diagnosing PE, for a total of 271 factors. They highlighted that CDS assistance in ordering diagnostic tests following a risk assessment (part of the “prompting” criteria) was a facilitator of the utility of this tool in PE diagnosis. The majority of facilitating factors were related to the “minimal actions” criteria, such as automatic population of vitals signs into the CDS. Many barriers to PE diagnosis usability were issues with the “compatibility” criteria, such as workflow integration, which was not considered in the HFE-based design of the CDS. “For example, the CDS did not support resident and attending physician teamwork in the PE diagnostic process,” the authors supplied.

Ultimately though, the researchers deemed that the use of HFE principles in the design of clinical decision support systems was promising for improving the technology’s usability. Regarding specific guidance, they reiterated that “workflow integration should be explicitly considered in the design of health IT,” in order to further improve usability.