Integrating Usability Into Development of a Clinical Decision Support System

Hospital leadership identified poor physician compliance with a patient treatment protocol that was intended to avoid the occurrence of blood clots in hospitalized patients. The computerized physician order entry (CPOE) system at that time was user driven; that is, no clinical decision support pathways were built into the system. Initial plans were to integrate a decision tree into the CPOE system, but leaders recognized that if physicians found the system to be cumbersome, they might refuse to use the system or develop workaround strategies. In order to minimize this possibility hospital leaders recognized a need for human factors engineering (HFE) input in the development of the system, but there was minimal funding and a short timeline allotted for this project. Through collaboration of a hospital physician having Human Factors knowledge and an external usability consultant, a successful pathway was added to the existing CPOE. The development of the pathway engaged relevant hospital personnel and utilized a special timesaving usability testing procedure. Implementation of the pathway resulted in improved physician compliance with the treatment protocol.