title: How usability of a web-based clinical decision support system has the potential to contribute to adverse medical events.
abstract: BACKGROUND
  Clinical decision support systems (CDSS) have the potential to reduce adverse medical events, but improper design can introduce new forms of error. CDSS pertaining to community acquired pneumonia and neutropenic fever were studied to determine whether usability of the graphical user interface might contribute to potential adverse medical events.
  
  
  METHODS
  Automated screen capture of 4 CDSS being used by volunteer emergency physicians was analyzed using structured methods.
  
  
  RESULTS
  422 events were recorded over 56 sessions. In total, 169 negative comments, 55 positive comments, 130 neutral comments, 21 application events, 34 problems, 6 slips, and 5 mistakes were identified. Three mistakes could have had life-threatening consequences.
  
  
  CONCLUSIONS
  Evaluation of CDSS will be of utmost importance in the future with increasing use of electronic health records. Usability engineering principles can identify interface problems that may lead to potential medical adverse events, and should be incorporated early in the software design phase.
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Timothy A D
authors.initials: TA
authors.lastname: Graham
authors.forename: Andre W
authors.initials: AW
authors.lastname: Kushniruk
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bullard
authors.forename: Brian R
authors.initials: BR
authors.lastname: Holroyd
authors.forename: David P
authors.initials: DP
authors.lastname: Meurer
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D020000:Decision Support Systems, Clinical; D020407:Internet; D019300:Medical Errors / Q000517:prevention & control*; D016347:Medical Records Systems, Computerized; D018570:Risk Assessment; D012307:Risk Factors