Methodological Review
Interface design principles for usable decision support: A targeted review of best practices for clinical prescribing interventions

https://doi.org/10.1016/j.jbi.2012.09.002Get rights and content
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Abstract

Developing effective clinical decision support (CDS) systems for the highly complex and dynamic domain of clinical medicine is a serious challenge for designers. Poor usability is one of the core barriers to adoption and a deterrent to its routine use. We reviewed reports describing system implementation efforts and collected best available design conventions, procedures, practices and lessons learned in order to provide developers a short compendium of design goals and recommended principles. This targeted review is focused on CDS related to medication prescribing.

Published reports suggest that important principles include consistency of design concepts across networked systems, use of appropriate visual representation of clinical data, use of controlled terminology, presenting advice at the time and place of decision making and matching the most appropriate CDS interventions to clinical goals.

Specificity and contextual relevance can be increased by periodic review of trigger rules, analysis of performance logs and maintenance of accurate allergy, problem and medication lists in health records in order to help avoid excessive alerting.

Developers need to adopt design practices that include user-centered, iterative design and common standards based on human–computer interaction (HCI) research methods rooted in ethnography and cognitive science. Suggestions outlined in this report may help clarify the goals of optimal CDS design but larger national initiatives are needed for systematic application of human factors in health information technology (HIT) development. Appropriate design strategies are essential for developing meaningful decision support systems that meet the grand challenges of high-quality healthcare.

Highlights

► Alerts should be tiered by severity, have concise text, justification, clear response options. ► Prioritize concurrent alerts, use controlled color sets, consistent terminology. ► Format text to visually associate drug categories, show clinical context data. ► Maintain manageable pick lists, allow multiple entry options and custom order sets.

Keywords

Clinical decision support systems (CDSSs)
Electronic health records systems (EHRs)
System design and development
Software usability
Human–computer interaction (HCI)
Patient safety

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