PT - JOURNAL ARTICLE AU - Pascale Carayon AU - Peter Hoonakker AU - Ann Schoofs Hundt AU - Megan Salwei AU - Douglas Wiegmann AU - Roger L Brown AU - Peter Kleinschmidt AU - Clair Novak AU - Michael Pulia AU - Yudi Wang AU - Emily Wirkus AU - Brian Patterson TI - Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study AID - 10.1136/bmjqs-2019-009857 DP - 2020 Apr 01 TA - BMJ Quality & Safety PG - 329--340 VI - 29 IP - 4 4099 - http://qualitysafety.bmj.com/content/29/4/329.short 4100 - http://qualitysafety.bmj.com/content/29/4/329.full SO - BMJ Qual Saf2020 Apr 01; 29 AB - 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.