Human Factors in System Design: Usability Testing of a Complex CDS Tool in an Emergency Department

Running head: HUMAN FACTORS IN SYSTEM DESIGN
Human Factors in System Design: Usability Testing of a Complex CDS Tool
in an Emergency Department
Name of Student-
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Author’s Note-

1Human Factors in System Design
Part One: Interactive System and its Users
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 (Press et al. 2015). 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. Conducting usability testing is hypothesized prior to
integration of the Wells score into an emergency room EHR will result in increased adoption
rates by physicians.
The usability testing of a CDS tool in the emergency department HER was conducted.
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 (Wiklund, Kendler and Strochlic 2015). 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.

2Human Factors in System Design

3Human Factors in System Design
Part Two: Use Cases
Figure 1: Use Case of Clinical Decision Support Tool
(Source: Created by Author)
Part Three: The Usability Requirement
Clinical decision support (CDS) tools for pulmonary embolism (PE) diagnosis have been
designed and implemented over the past several years with limited success. Tools have been
designed to alert physicians during the order entry section of the electronic health record (EHR).
However, physicians either dismissed or were noncompliant with the PE CDS tool. With more