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. 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

Emily Beth Devine  1 , Chia-Ju Lee  2 , Casey L Overby  3 , Neil Abernethy  4 , Jeannine McCune  5 , Joe W Smith  6 , Peter Tarczy-Hornoch  7
Affiliations

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

Emily Beth Devine et al. Int J Med Inform. 2014 Jul.

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.

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Conflict of interest statement

Conflict of Interest Statement

Emily Beth Devine: has no conflicts to declare

Casey L. Overby: has no conflicts to declare

Chia-Ju Lee: has no conflicts to declare

Neil Abernethy: has no conflicts to declare

Jeannine McCune: has no conflicts to declare

Joe W. Smith: has no conflicts to declare Peter

Tarczy-Hornoch: has no conflicts to declare

Figures

Figure 1
Figure 1
a: Case Scenario, PGx Allelic Variants, Phenotype, and Infobutton® b: Clinical Decision Support Alert in Discern® System
Figure 1
Figure 1
a: Case Scenario, PGx Allelic Variants, Phenotype, and Infobutton® b: Clinical Decision Support Alert in Discern® System
Figure 2
Figure 2
Heuristic Evaluation Results
Figure 3
Figure 3
a: Results – Domain 1: Improvements that could be made to the CPOE user interface PowerChart® – Orders Tab and Orders Details b: Results – Domain 2: Improvements that could be made to the PGx-CDS presentation
Figure 3
Figure 3
a: Results – Domain 1: Improvements that could be made to the CPOE user interface PowerChart® – Orders Tab and Orders Details b: Results – Domain 2: Improvements that could be made to the PGx-CDS presentation
See this image and copyright information in PMC

References

    1. Green ED, Guyer MS. National Human Genome Research Institute. Charting a course for genomic medicine from base pairs to bedside. Nature. 2011;470(7333):204–213. - PubMed
    1. Realizing the Potential of Pharmacogenomics. [Accessed: March 14, 2014];Opportunities and Challenges. Report of the Secretary’s Advisory Committee on Genetics, Health, and Society. 2008 May; Available from: http://osp.od.nih.gov/sites/default/files/SACGHS_PGx_report.pdf.
    1. United States Food and Drug Administration. [Accessed: March 14, 2014];Table of Pharmacogenomic Biomarkers in Drug Labels. Available from: http://www.fda.gov/drugs/scienceresearch/researchareas/pharmacogenetics/....
    1. Stanek EJ, Sanders CL, Teagarden JR, Johansen KA, Aubert RE, Agatep BC, Khalid M, Patel A, Frueh FW, Epstein RS. Presented at the 59th Annual Meeting of the American Society of Human Genetics. Honolulu, Hawaii: 2009. Oct, Who are adopters of pharmacogenomics among U.S. physicians? abstract.
    1. Sanders CL, Stanek EJ, Teagarden JR, Agatep BC, Johansen KA, Aubert RE, Khalid M, Patel A, Frueh FW, Epstein RS. Honolulu, Hawaii: Presented at the 59th Annual Meeting of the American Society of Human Genetics; Oct, 2009. Putting knowledge into practice: well informed physicians are twice as likely to order or recommend pharmacogenetic testing. abstract.

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