Abstract
Background
Clinical decision support systems (CDSS) are central to modern health care, but their
effectiveness is compromised during system downtimes, which affect 96% of health care
organizations. During these failures, clinicians lose access to critical decision-making
tools like order sets, increasing the risk of medical errors. Traditional downtime
solutions, such as paper-based protocols, are often impractical and difficult to maintain.
Objectives
This study introduces and evaluates Offsite Repository for Clinical Assets (ORCA),
a resilient web-based solution designed to maintain access to electronic health record
(EHR) order sets during system failures. We assessed its usability and effectiveness
as a downtime decision support tool across various clinical settings.
Methods
ORCA was developed based on an analysis of previous downtime incidents, replicating
essential order set functionality while ensuring offsite accessibility. We conducted
usability testing with 16 clinicians from diverse specialties, using structured tasks
and think-aloud protocols. User feedback was collected through the Usability Metric
for User Experience (UMUX) questionnaire and thematic analysis of interview transcripts.
Results
ORCA demonstrated strong usability (mean UMUX score: 86.2). Thematic analysis revealed
key implementation challenges: system limitations, workflow integration, and interface
navigation. Users valued ORCA's familiar interface and offsite accessibility but identified
critical gaps in dynamic decision support capabilities.
Conclusion
ORCA represents a viable approach to maintaining basic clinical decision support (CDS)
during downtimes. However, significant challenges remain in replicating dynamic CDS
features and ensuring effective integration with existing downtime procedures. These
findings inform future development of resilient CDSS and highlight the importance
of planned fallback pathways in clinical systems.
Keywords
EHRs and systems - clinical decision support - human–computer interaction
