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Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study
  1. Pascale Carayon1,
  2. Peter Hoonakker2,
  3. Ann Schoofs Hundt2,
  4. Megan Salwei1,
  5. Douglas Wiegmann1,
  6. Roger L Brown3,
  7. Peter Kleinschmidt4,
  8. Clair Novak5,
  9. Michael Pulia6,
  10. Yudi Wang4,
  11. Emily Wirkus7,
  12. Brian Patterson6
  1. 1Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
  2. 2Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, USA
  3. 3School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
  4. 4Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
  5. 5UW Health, Madison, Wisconsin, USA
  6. 6Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
  7. 7Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
  1. Correspondence to Dr Pascale Carayon, Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA; pcarayon{at}wisc.edu

Abstract

Objective In 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 methods We 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).

Results Emergency 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.

Conclusions This 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.

  • diagnostic errors
  • human factors
  • decision support, clinical
  • emergency department
  • decision making
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Footnotes

  • Contributors PC, ASH, PH, BP and DW designed the study. All authors were involved in the human-centered design process, data collection and data analysis. All authors reviewed the manuscript before submission.

  • Funding This research was made possible by funding from the Agency for Healthcare Research and Quality (AHRQ), Grant Numbers: R01HS022086-Principal Investigator: Pascale Carayon, and K08HS024558-Principal Investigator: Brian Patterson; and was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), Grant Number: 1UL1TR002373. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ or NIH.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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