How usability of a web-based clinical decision support system has the potential to contribute to adverse medical events.
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.
Graham
Timothy A D
TA
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada.
Kushniruk
Andre W
AW
Bullard
Michael J
MJ
Holroyd
Brian R
BR
Meurer
David P
DP
Rowe
Brian H
BH
D020000:Decision Support Systems, Clinical; D020407:Internet; D019300:Medical Errors / Q000517:prevention & control*; D016347:Medical Records Systems, Computerized; D018570:Risk Assessment; D012307:Risk Factors