title: Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation.
abstract: OBJECTIVE
  To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors.
  
  
  METHODS
  We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug-allergy, drug-drug interaction, and drug-disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors.
  
  
  RESULTS
  Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1-5) compared to original alerts: 4 (1-7); p=0.024).
  
  
  CONCLUSIONS
  Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts.
  
  
  CONCLUSIONS
  This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes.
authors.affiliation: Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, Department of Veterans Affairs, Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA Indiana University Center for Health Services and Outcomes Research and Regenstrief Institute, Inc., Indianapolis, Indiana, USA College of Pharmacy, Purdue University, West Lafayette, Indiana, USA.
authors.forename: Alissa L
authors.initials: AL
authors.lastname: Russ
authors.affiliation: Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, Department of Veterans Affairs, Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA Indiana University Center for Health Services and Outcomes Research and Regenstrief Institute, Inc., Indianapolis, Indiana, USA College of Pharmacy, Purdue University, West Lafayette, Indiana, USA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Zillich
authors.affiliation: School of Pharmacy, University of Kansas, Lawrence, Kansas, USA.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Melton
authors.affiliation: Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, Department of Veterans Affairs, Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Russell
authors.affiliation: Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, Department of Veterans Affairs, Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.
authors.forename: Siying
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Spina
authors.affiliation: Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, Department of Veterans Affairs, Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA Indiana University Center for Health Services and Outcomes Research and Regenstrief Institute, Inc., Indianapolis, Indiana, USA Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Weiner
authors.affiliation: Department of Psychology, Purdue University, West Lafayette, Indiana, USA.
authors.forename: Elizabette G
authors.initials: EG
authors.lastname: Johnson
authors.affiliation: Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, Department of Veterans Affairs, Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Joanne K
authors.initials: JK
authors.lastname: Daggy
authors.affiliation: Department of Nephrology Services, Department of Veterans Affairs, Temple, Texas, USA.
authors.forename: M Sue
authors.initials: MS
authors.lastname: McManus
authors.affiliation: Department of Veterans Affairs, Office of Information, Bay Pines, Florida, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hawsey
authors.affiliation: Department of Veterans Affairs, Office of Information, Salt Lake City, Utah, USA.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Puleo
authors.affiliation: Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, Department of Veterans Affairs, Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA Indiana University Center for Health Services and Outcomes Research and Regenstrief Institute, Inc., Indianapolis, Indiana, USA Department of BioHealth Informatics, School of Informatics and Computing, Indiana University-Purdue University, Indianapolis, Indiana, USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
authors.affiliation: Human Factors Engineering, Ofﬁce of Informatics and Analytics, Veterans Health Administration, Louisville, Kentucky, USA.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Saleem
mesh_terms: D020000:Decision Support Systems, Clinical; D004360:Drug Therapy, Computer-Assisted; D006804:Ergonomics; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D055656:Prescriptions; D017010:Reminder Systems; D014584:User-Computer Interface