Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: A mixed methods approach |
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| Affiliation: | 1. Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States;2. Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, United States;3. Department of Health Services, University of Washington, Seattle, WA, United States;4. 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);5. UW Medicine Pharmacy Informatics, University of Washington, Seattle, WA, United States;6. Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA, United States;7. Department of Computer Science and Engineering, University of Washington, Seattle, WA, United States;1. Division of Nursing Business & Health Systems, University of Michigan School of Nursing, Ann Arbor, MI, USA;2. Office of Global Outreach, University of Michigan School of Nursing, Ann Arbor, MI, USA;3. School of Nursing, Queensland University of Technology, Brisbane, Australia;4. School of Nursing, Universidade Federal de São Paulo, Brazil;5. Center for Patient Safety, Research & Practice, Brigham and Women''s Hospital, MA, USA;6. Center for Nursing Excellence, Brigham and Women''s Hospital, MA, USA;7. Harvard Medical School, Boston, MA, USA;1. Department of Bioethics and Humanities, University of Washington, Seattle, WA;2. Department of Public Health & Preventive Medicine, Oregon Health & Science University School of Medicine, Portland, OR;3. School of Nursing, Oregon Health & Science University, Portland, OR;1. The University of Texas Health Science Center at Houston, United States;2. Harvard School of Dental Medicine, United States;3. University of California, San Francisco, United States;4. Harvard Medical School, United States;5. Tufts University, United States;6. Creighton University, United States;7. Academic Centre for Dentistry at Amsterdam (ACTA), United States;8. The New York Academy of Medicine, United States;1. Department of Health Sciences Research, Mayo Clinic, Rochester, MN;2. Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN;3. Center for Individualized Medicine, Mayo Clinic, Rochester, MN;4. Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN;5. Division of General Internal Medicine, Mayo Clinic, Rochester, MN;6. Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN;7. Division of Gastroenterology, Mayo Clinic, Rochester, MN;8. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN;9. Department of Information Technology, Mayo Clinic, Rochester, MN;10. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN;11. Gastroenterology Department, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI;12. The Hastings Center, Garrison, NY;1. Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia;2. St Vincent’s Clinical School, UNSW Australia;3. The Sydney Children’s Hospital Network, Australia;1. Section for Medical Expert and Knowledge-Based Systems, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria;2. IT Systems & Communications, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria |
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| Abstract: | ![]()
BackgroundPharmacogenomics (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.ObjectivesThe 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.MethodsUsing 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.ResultsNine 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).ConclusionsUsability 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. |
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| Keywords: | Clinical decision support systems Clinical knowledge resources (not a MeSH term) Medical order entry systems Pharmacogenetics User-computer interface |
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