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. 2019 Apr 17;6(2):e12469.
doi: 10.2196/12469.

Interruptive Versus Noninterruptive Clinical Decision Support: Usability Study

Saul Blecker  1   2 , Rishi Pandya  2 , Susan Stork  1 , Devin Mann  1 , Gilad Kuperman  3 , Donna Shelley  1 , Jonathan S Austrian  2
Affiliations

Interruptive Versus Noninterruptive Clinical Decision Support: Usability Study

Saul Blecker et al. JMIR Hum Factors. .

Abstract

Background: Clinical decision support (CDS) has been shown to improve compliance with evidence-based care, but its impact is often diminished because of issues such as poor usability, insufficient integration into workflow, and alert fatigue. Noninterruptive CDS may be less subject to alert fatigue, but there has been little assessment of its usability.

Objective: This study aimed to study the usability of interruptive and noninterruptive versions of a CDS.

Methods: We conducted a usability study of a CDS tool that recommended prescribing an angiotensin-converting enzyme inhibitor for inpatients with heart failure. We developed 2 versions of the CDS: an interruptive alert triggered at order entry and a noninterruptive alert listed in the sidebar of the electronic health record screen. Inpatient providers were recruited and randomly assigned to use the interruptive alert followed by the noninterruptive alert or vice versa in a laboratory setting. We asked providers to "think aloud" while using the CDS and then conducted a brief semistructured interview about usability. We used a constant comparative analysis informed by the CDS Five Rights framework to analyze usability testing.

Results: A total of 12 providers participated in usability testing. Providers noted that the interruptive alert was readily noticed but generally impeded workflow. The noninterruptive alert was felt to be less annoying but had lower visibility, which might reduce engagement. Provider role seemed to influence preferences; for instance, some providers who had more global responsibility for patients seemed to prefer the noninterruptive alert, whereas more task-oriented providers generally preferred the interruptive alert.

Conclusions: Providers expressed trade-offs between impeding workflow and improving visibility with interruptive and noninterruptive versions of a CDS. In addition, 2 potential approaches to effective CDS may include targeting alerts by provider role or supplementing a noninterruptive alert with an occasional, well-timed interruptive alert.

Keywords: clinical decision support; electronic health records; hospital.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Screenshot of clinical decision support used in usability testing: interruptive version of clinical decision support. Source: Epic Systems Corporation; used with permission. ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; BP: blood pressure; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction.
Figure 2
Figure 2
Screenshot of clinical decision support used in usability testing: location of noninterruptive version of clinical decision support, highlighted by the arrow. Clicking the link in the noninterruptive alert would take the user to a screen similar to the interruptive alert. Source: Epic Systems Corporation; used with permission. ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; BP: blood pressure.
See this image and copyright information in PMC

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