Introduction
Clinical decision support (CDS) systems can safely and effectively support medication prescribing when they deliver relevant, unambiguous and actionable advice well integrated into patient care [1], [2], [3]. Many contemporary installations, however, have poor interface design, use verbose or unclear language, non-standard terminology, alerts may be temporally misalignment with corresponding clinical tasks and their important human–computer interaction (HCI) attributes may be inadequate, making the receiving and responding to decision support interventions difficult.
There is a recognized and pressing need for high-performing CDS. Aside from an array of successes at specific sites in individual domains, few systems have substantially delivered on the promise to improve healthcare processes and outcomes [4]. The challenges of designing effective but potentially work-disruptive alerts and notifications are manifold and often require the reconciliation of contradictory goals, such as the need for succinctness with the need to adequately support complex medical decisions.
Designers and developers of health information technology (HIT) need a cohesive, widely accepted and reliable set of industry standards, recommendations and best practices to substantially increase the usability, effectiveness and safety of electronic health records (EHRs) and CDS systems. Such guidelines must be rooted in empirical evidence from biomedical informatics and HCI research, follow recognized usability principles and be informed by decades of software design and evaluation experience from other safety-critical domains.
This report describes design recommendations for CDS interventions that are activated during medication prescribing, such as alerts to drug and allergy interactions. We reviewed published reports on the successes, failures and lessons learned from CDS implementation in large hospitals and small clinics and interpreted the findings with regard to HCI principles and software usability. Emerging themes and specific suggestions were then formulated into a set of design recommendations for CDS interventions that would improve their effectiveness, safety and human interaction by, for example, reducing unnecessary workflow interruptions or allowing clinicians to make informed decisions quickly, accurately and without extraneous cognitive and interactive effort. A related methodological review of design approaches that are applicable to a wider range of decision support and EHR systems can be found in a recent JBI article [5].
This targeted review was focused on articles containing references to design features of CDS and therefore was not exhaustive. The recommendations, however, are not limited to specific CDS and EHR systems as they are partially derived from and reconciled with existing general usability principles. They are organized in the following sections according to specific design goals, with high-level principles and examples of their specific application.