Applying human factors research to electronic prescribing clinical decision support

Abstract

Clinical decision support in electronic prescribing (e-Rx) systems can improve patient safety and quality of care. Despite the availability of drug information knowledgebases and decision support modules, users often disable this functionality or customize it to minimize irrelevant or insignificant alerts, due to concerns about alert fatigue, i.e., decreasing the "attention cost" of alerts. We postulate that novel user interfaces may decrease the "attention cost" of alerts, as has been shown in inpatient CPOE. This study explores alternative approaches to display alerts, and examines whether and how human factors based interface design can be used to improve signal detection from noisy data (alerts and reminders) in an existing e-Rx system. The issues in presenting multiple drug alerts in an outpatient e-Rx system are described. Several novel drug alert presentation interfaces are introduced. Both expert evaluation and formal usability testing show that the TreeDashboard-View is better perceived than the text-centric ScrollText-View in delivering multiple drug alerts during e-Rx practice. Physician prescribers' perceptions are discussed.