@article{13104,
  author = {Pascale Carayon and Peter Hoonakker and Ann Schoofs Hundt and Megan Salwei and Douglas A. Wiegmann and Roger L. Brown and Peter Kleinschmidt and Clair Novak and Michael Pulia and Yudi Wang and Emily Wirkus and Brian Patterson},
  title = {Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study},
  abstract = {<jats:sec><jats:title>Objective</jats:title><jats:p>In this study, we used human factors (HF) methods and principles to design a clinical decision support (CDS) that provides cognitive support to the pulmonary embolism (PE) diagnostic decision-making process in the emergency department. We hypothesised that the application of HF methods and principles will produce a more usable CDS that improves PE diagnostic decision-making, in particular decision about appropriate clinical pathway.</jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p>We conducted a scenario-based simulation study to compare a HF-based CDS (the so-called CDS for PE diagnosis (PE-Dx CDS)) with a web-based CDS (MDCalc); 32 emergency physicians performed various tasks using both CDS. PE-Dx integrated HF design principles such as automating information acquisition and analysis, and minimising workload. We assessed all three dimensions of usability using both objective and subjective measures: effectiveness (eg, appropriate decision regarding the PE diagnostic pathway), efficiency (eg, time spent, perceived workload) and satisfaction (perceived usability of CDS).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Emergency physicians made more appropriate diagnostic decisions (94% with PE-Dx; 84% with web-based CDS; p&lt;0.01) and performed experimental tasks faster with the PE-Dx CDS (on average 96 s per scenario with PE-Dx; 117 s with web-based CDS; p&lt;0.001). They also reported lower workload (p&lt;0.001) and higher satisfaction (p&lt;0.001) with PE-Dx.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This simulation study shows that HF methods and principles can improve usability of CDS and diagnostic decision-making. Aspects of the HF-based CDS that provided cognitive support to emergency physicians and improved diagnostic performance included automation of information acquisition (eg, auto-populating risk scoring algorithms), minimisation of workload and support of decision selection (eg, recommending a clinical pathway). These HF design principles can be applied to the design of other CDS technologies to improve diagnostic safety.</jats:p></jats:sec>},
  year = {2020},
  journal = {BMJ Qual Saf},
  volume = {29},
  pages = {329-340},
  month = {11/2019},
  issn = {2044-5415},
  doi = {10.1136/bmjqs-2019-009857},
}