Abstract
Objectives
This study aimed to develop a human factors assessment for medication-related clinical
decision support (CDS) based on a previously validated tool that assessed the integration
of human factors principles in CDS, the instrument for evaluating human factors principles
in medication-related decision support alerts (I-MeDeSA), and pilot it with 10 outpatient
clinics across the United States.
Methods
The human factors assessment was developed based on past validations of I-MeDeSA.
Examples included changing the wording of questions and reformatting answer choices
to check-box options, allowing for multiple answer choices. We also added a section
about how clinicians resolved alerts. Clinics received a percentage score based on
how well their CDS adhered to human factors principles. To take the assessment, testing
teams at each clinic triggered a high-severity drug–drug interaction (DDI) alert,
and then took the human factors assessment. This assessment was piloted in 10 outpatient
clinics, each of which used a different commercial electronic health record (EHR)
system.
Results
The final assessment included five sections and twelve questions related to aspects
like the timing, visual aspect, severity, content, and actions within the DDI alert.
The mean overall percentage score was 62%. The sections regarding the timing and visual
aspects of the alert were ones where clinics' EHRs performed the best. However, in
the “actions” section, 40% of the clinics could bypass high severity alerts without
any safeguards in place.
Conclusion
We found substantial variability in the integration of human factors principles in
the design and delivery of DDI alerts among the outpatient clinics, and some lacked
important medication safeguards. This assessment can be used by outpatient clinics
for safety improvement initiatives.
Keywords
medication safety - quality of care - psychological burnout - ambulatory care - electronic
health record - human factors - usability - artificial intelligence
