Format

Send to

Choose Destination
Int J Med Inform. 2014 Jul;83(7):473-83. doi: 10.1016/j.ijmedinf.2014.04.008. Epub 2014 May 9.

Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach.

Author information

1
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States. Electronic address: bdevine@uw.edu.
2
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States.
3
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Department of Medicine, Program in Personalized and Genomic Medicine, University of Maryland, Baltimore, MD, United States (formerly Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA United States).
4
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, United States.
5
Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, United States.
6
UW Medicine Pharmacy Informatics, University of Washington, Seattle, WA, United States.
7
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA, United States; Department of Computer Science and Engineering, University of Washington, Seattle, WA, United States.

Abstract

BACKGROUND:

Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption.

OBJECTIVES:

The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers.

METHODS:

Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making.

RESULTS:

Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree).

CONCLUSIONS:

Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and useful ways.

KEYWORDS:

Clinical decision support systems; Clinical knowledge resources (not a MeSH term); Medical order entry systems; Pharmacogenetics; User-computer interface

PMID:
24874987
PMCID:
PMC4095746
DOI:
10.1016/j.ijmedinf.2014.04.008
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center