Usability Testing of a Complex Clinical Decision Support Tool in the Emergency Department: Lessons Learned.
Usability Testing of a Complex Clinical Decision Support Tool in the Emergency Department: Lessons Learned.
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DOI：
10.2196/humanfactors.4537
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发表时间：
2015-09-10
影响因子：
2.7
通讯作者：
McGinn T
中科院分区：
文献类型：
--
作者：
Press A;McCullagh L;Khan S;Schachter A;Pardo S;McGinn T
随着电子健康记录 (EHR) 成为医疗实践中首选的记录工具，医疗保健组织正在推动临床决策支持系统 (CDSS)，以帮助将临床决策支持 (CDS) 工具带到患者与医生互动的最前沿。 CDSS 集成到 EHR 中，使医生能够轻松使用 CDS 工具。然而，CDSS 通常在没有进行初始阶段可用性测试的情况下就集成到 EHR 中，导致采用率较低。可用性测试很重要，因为它通过对实际用户进行测试来评估 CDSS。本文概述了一项研究的可用性阶段，该研究将测试将用于肺栓塞 (PE) 诊断的 Wells CDSS 集成到大型城市急诊科的影响，该科室的工作流程通常很混乱，并且经常做出高风险的决策。我们假设，在将 Wells 评分整合到急诊室 EHR 之前进行可用性测试将提高医生的采用率。该研究的目的是进行可用性测试，以将 Wells 临床预测规则集成到三级护理中心的急诊科 EHR 中。我们在急诊科 EHR 中对 CDS 工具进行了可用性测试。 CDS 工具由计算器形式的威尔斯 PE 规则组成，并根据计算机断层扫描 (CT) 命令或患者的主诉触发。该研究是在纽约皇后区的一家三级医院进行的。招募了七名居民并参与了两个阶段的可用性测试。可用性测试采用了“大声思考”方法和“近乎实时”的临床模拟，其中护理人员与标准化患者互动，制定临床场景。两个阶段都进行了录音、录像，并激活了屏幕捕捉软件进行屏幕录制。第一阶段：研究“出声思考”阶段的数据显示，Wells 工具在评估患者 PE 诊断方面总体上持积极态度。受试者将该工具描述为“组织良好”且“优于临床判断”。我们进行了一些更改，以改进 EHR 中的工具放置方式，使其最适合决策、自动填充框并最大限度地减少点击疲劳。第二阶段：在纳入第一阶段中提到的更改后，参与者注意到工具的改进。屏幕之间的切换较少，他们拥有完成该工具所需的所有临床信息，并且能够高效地完成患者就诊。然而，触发该工具的最佳位置仍然存在争议。这项研究成功地将“有声思考”协议分析与“近实时”临床模拟结合起来，对将在急诊室环境中实施的 CDS 工具进行可用性评估。事实证明，这两种方法在 CDS 工具的评估中都很有用，并使我们能够改进工具的可用性和工作流程。
As the electronic health record (EHR) becomes the preferred documentation tool across medical practices, health care organizations are pushing for clinical decision support systems (CDSS) to help bring clinical decision support (CDS) tools to the forefront of patient-physician interactions. A CDSS is integrated into the EHR and allows physicians to easily utilize CDS tools. However, often CDSS are integrated into the EHR without an initial phase of usability testing, resulting in poor adoption rates. Usability testing is important because it evaluates a CDSS by testing it on actual users. This paper outlines the usability phase of a study, which will test the impact of integration of the Wells CDSS for pulmonary embolism (PE) diagnosis into a large urban emergency department, where workflow is often chaotic and high stakes decisions are frequently made. We hypothesize that conducting usability testing prior to integration of the Wells score into an emergency room EHR will result in increased adoption rates by physicians. The objective of the study was to conduct usability testing for the integration of the Wells clinical prediction rule into a tertiary care center’s emergency department EHR. We conducted usability testing of a CDS tool in the emergency department EHR. The CDS tool consisted of the Wells rule for PE in the form of a calculator and was triggered off computed tomography (CT) orders or patients’ chief complaint. The study was conducted at a tertiary hospital in Queens, New York. There were seven residents that were recruited and participated in two phases of usability testing. The usability testing employed a “think aloud” method and “near-live” clinical simulation, where care providers interacted with standardized patients enacting a clinical scenario. Both phases were audiotaped, video-taped, and had screen-capture software activated for onscreen recordings. Phase I: Data from the “think-aloud” phase of the study showed an overall positive outlook on the Wells tool in assessing a patient for a PE diagnosis. Subjects described the tool as “well-organized” and “better than clinical judgment”. Changes were made to improve tool placement into the EHR to make it optimal for decision-making, auto-populating boxes, and minimizing click fatigue. Phase II: After incorporating the changes noted in Phase 1, the participants noted tool improvements. There was less toggling between screens, they had all the clinical information required to complete the tool, and were able to complete the patient visit efficiently. However, an optimal location for triggering the tool remained controversial. This study successfully combined “think-aloud” protocol analysis with “near-live” clinical simulations in a usability evaluation of a CDS tool that will be implemented into the emergency room environment. Both methods proved useful in the assessment of the CDS tool and allowed us to refine tool usability and workflow.