title: Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach.
abstract: BACKGROUND
  Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption.
  
  
  OBJECTIVE
  The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers.
  
  
  METHODS
  Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making.
  
  
  RESULTS
  Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree).
  
  
  CONCLUSIONS
  Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and useful ways.
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States. Electronic address: bdevine@uw.edu.
authors.forename: Emily Beth
authors.initials: EB
authors.lastname: Devine
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States.
authors.forename: Chia-Ju
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Department of Medicine, Program in Personalized and Genomic Medicine, University of Maryland, Baltimore, MD, United States (formerly Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA United States).
authors.forename: Casey L
authors.initials: CL
authors.lastname: Overby
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, United States.
authors.forename: Neil
authors.initials: N
authors.lastname: Abernethy
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, United States.
authors.forename: Jeannine
authors.initials: J
authors.lastname: McCune
authors.affiliation: UW Medicine Pharmacy Informatics, University of Washington, Seattle, WA, United States.
authors.forename: Joe W
authors.initials: JW
authors.lastname: Smith
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA, United States; Department of Computer Science and Engineering, University of Washington, Seattle, WA, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Tarczy-Hornoch
mesh_terms: D003657:Decision Making; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D008490:Medical Informatics; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control*; D010597:Pharmacogenetics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D057285:Precision Medicine
keywords: Clinical decision support systems; Clinical knowledge resources (not a MeSH term); Medical order entry systems; Pharmacogenetics; User-computer interface