Table 1

HF design of PE-Dx CDS

HF design processDesign activities and outcomes
1. HF analysis of PE diagnosis in the EDIdentification of multiple work system barriers and facilitators to cognitive work involved in PE diagnosis; in particular technology-related barriers for information gathering activities in PE diagnostic process
2. Analysis of suggestions made by ED physicians regarding health IT solutions Main suggestions for CDS to support PE diagnosis in ED included:
  •  Integration with EHR

  •  Auto-population

  •  Automated scoring

  •  Support for decision regarding order.

3. Nine interdisciplinary design sessions over 1 year for a total of 13.5 hours (each session was between 1 and 2 hours)Decision by design team to focus the CDS on how to support diagnostic pathway for PE diagnosis.
Multiple disciplines involved in design sessions: HF, emergency medicine and software engineering/programming.
Use of iterative design process with multiple mock-ups of PE-Dx CDS (created in PowerPoint)
4.Two 1-hour focus groups with four ED physicians (interspersed between design sessions) for review of PE-Dx CDS mock-upConfirmation of preference for two-step CDS: presentation of Wells’ and then PERC; match with hospital policy.
Use of highest heart rate/pulse value and lowest O2 saturation value; but need to allow physicians to update these values
5.Creation of PE-Dx CDS in EHR PlaygroundProgramming of PE-Dx CDS in EHR Playground based on PowerPoint mock-up
6.Two-hour participatory heuristic evaluation of PE-Dx CDS with seven participants (HF engineers, physicians, systems analyst)Identification of 19 usability problems; 13 problems resolved through design changes to PE-Dx CDS; six problems not addressed because of constraints of flowsheet functionality of local EHR
Production of final PE-Dx CDS tested in usability evaluation
  • ED, emergency department; IT, information technology; PE-Dx CDS, clinical decision support for pulmonary embolism diagnosis.