A usability study to improve a clinical decision support system for the prescription of antibiotic drugs

• Published in: PloS one 2019-09, Vol.14 (9), p.e0223073-e0223073
• Main Authors: Akhloufi, H, Verhaegh, S J C, Jaspers, M W M, Melles, D C, van der Sijs, H, Verbon, A
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial Stewardship - organization & administration; Bacterial infections; Bacterial Infections - drug therapy; Biology and Life Sciences; Care and treatment; Classification; Classification schemes; Clinical decision making; Clinical medicine; Complications and side effects; Computer and Information Sciences; Decision making; Decision support systems; Decision Support Systems, Clinical - organization & administration; Drug Prescriptions - statistics & numerical data; Drug Resistance, Bacterial; Electronic Health Records - statistics & numerical data; Empirical analysis; Evidence-based medicine; Family physicians; Health informatics; Hospital patients; Hospitalization; Humans; Infectious diseases; Information systems; Information technology; Internal medicine; Medical Order Entry Systems - organization & administration; Medical students; Medicine and Health Sciences; Mortality; Pathogens; Patients; People and Places; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Prescription drugs; Primary care; Program Evaluation; Quality Improvement; Redesign; Studies; Usability; User-Computer Interface
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0223073

A clinical decision support system (CDSS) for empirical antibiotic treatment has the potential to increase appropriate antibiotic use. Before using such a system on a broad scale, it needs to be tailored to the users preferred way of working. We have developed a CDSS for empirical antibiotic treatment in hospitalized adult patients. Here we determined in a usability study if the developed CDSS needed changes. Four prespecified patient cases, based on real life clinical scenarios, were evaluated by 8 medical residents in the study. The "think-aloud" method was used, and sessions were recorded and analyzed afterwards. Usability was assessed by 3 evaluators using an augmented classification scheme, which combines the User Action Framework with severity rating of the usability problems and the assessment of the potential impact of these problems on the final task outcomes. In total 51 usability problems were identified, which could be grouped into 29 different categories. Most (n = 17/29) of the usability problems were cosmetic problems or minor problems. Eighteen (out of 29) of the usability categories could have an ordering error as a result. Classification of the problems showed that some of the problems would get a low priority based on their severity rating, but got a high priority for their impact on the task outcome. This effectively provided information to prioritize system redesign efforts. Usability studies improve lay-out and functionality of a CDSS for empirical antibiotic treatment, even after development by a multidisciplinary system.