title: Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records.
abstract: BACKGROUND
  Screening, brief intervention, and referral to treatment (SBIRT) is currently being implemented into health systems nationally via paper and electronic methods.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the integration of an electronic SBIRT tool into an existing paper-based SBIRT clinical workflow in a patient-centered medical home.
  
  
  METHODS
  Usability testing was conducted in an academic ambulatory clinic. Two rounds of usability testing were done with medical office assistants (MOAs) using a paper and electronic version of the SBIRT tool, with two and four participants, respectively. Qualitative and quantitative data was analyzed to determine the impact of both tools on clinical workflow. A second round of usability testing was done with the revised electronic version and compared with the first version.
  
  
  RESULTS
  Personal workflow barriers cited in the first round of testing were that the electronic health record (EHR) tool was disruptive to patient's visits. In Round 2 of testing, MOAs reported favoring the electronic version due to improved layout and the inclusion of an alert system embedded in the EHR. For example, using the system usability scale (SUS), MOAs reported a grade "1" for the statement, "I would like to use this system frequently" during the first round of testing but a "5" during the second round of analysis.
  
  
  CONCLUSIONS
  The importance of testing usability of various mediums of tools used in health care screening is highlighted by the findings of this study. In the first round of testing, the electronic tool was reported as less user friendly, being difficult to navigate, and time consuming. Many issues faced in the first generation of the tool were improved in the second generation after usability was evaluated. This study demonstrates how usability testing of an electronic SBRIT tool can help to identify challenges that can impact clinical workflow. However, a limitation of this study was the small sample size of MOAs that participated. The results may have been biased to Northwell Health workers' perceptions of the SBIRT tool and their specific clinical workflow.
authors.affiliation: Hofstra Northwell School of Medicine, Manhasset, NY, United States. anniepress@gmail.com.
authors.forename: Anne
authors.identifier: http://orcid.org/0000-0001-5329-7715
authors.initials: A
authors.lastname: Press
authors.forename: Catherine
authors.identifier: http://orcid.org/0000-0002-0762-6087
authors.initials: C
authors.lastname: DeStio
authors.forename: Lauren
authors.identifier: http://orcid.org/0000-0002-0436-8094
authors.initials: L
authors.lastname: McCullagh
authors.forename: Sandeep
authors.identifier: http://orcid.org/0000-0002-1581-6403
authors.initials: S
authors.lastname: Kapoor
authors.forename: Jeanne
authors.identifier: http://orcid.org/0000-0003-0740-1424
authors.initials: J
authors.lastname: Morley
authors.forename: Joseph
authors.identifier: http://orcid.org/0000-0001-6273-4024
authors.initials: J
authors.lastname: Conigliaro
keywords: SBIRT; adoption; clinical decision support; primary care; usability