312 - Leveraging Usability Testing to Optimize Clinical Decision Support Tools to Improve Appropriate Antimicrobial Prescribing for Acute Respiratory Tract Infections in Children

Publication Number: 1296.312

Emma G. Kelly, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States; Janet Lee, Lewis Katz School of Medicine at Temple University, Jenkintown, PA, United States; Dina Abdel-Rahman, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States; Praveena Korakuti, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States; Emilie Sienko, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States

Background: Clinical decision support (CDS) tools in electronic health records (EHRs) can improve guideline adherent prescribing. Despite this, poorly designed CDS tools can hinder workflows and can contribute to provider burnout. Conducting usability testing sessions with potential users of CDS tools has been shown to improve overall satisfaction and decrease feelings of burnout. As part of a large implementation science project, we designed a new suite of CDS tools to support appropriate antimicrobial prescribing for pediatric patients seen in an urban health system.

Objective: The objective of this study was to conduct usability testing sessions with potential users of the CDS tools to obtain structured feedback and iteratively create updates to the builds.

Design/Methods: Three interruptive CDS alerts were built into our HER testing environment to support appropriate antimicrobial prescribing for acute respiratory tract infections (ARTIs) in pediatric patients. Twelve providers from the Pediatrics and Family Medicine departments were recruited to participate in remote usability testing sessions. We employed think-aloud techniques to guide participants through scripted scenarios. Providers were grouped into four waves of three. Rapid qualitative analysis allowed us to iteratively edit the tools after each wave until thematic saturation was reached. Quantitative data including efficiency, effectiveness, and satisfaction ratings were collected and analyzed in Microsoft Excel. Qualitative data was recorded and evaluated in a Rainbow Diagram, a matrix-based summary table created to identify common themes.

Results: 83% of the participants were able to complete the tasks successfully. Successful task completion improved as iterative changes were made to the tools. Overall, participants were very satisfied with the tasks. Participants unanimously noted that pop-up alerts are interruptive and can lead to negative emotions. However, participants noted that they very satisfied with having additional activity buttons to resolve the alert located within the same pop-up activity. Inclusion of hyperlinks and rationale for clinical guidance improved trust and fostered positive emotions toward the alert.

Conclusion(s): Usability testing is an effective way to optimize EHR tools to support new workflows and practice change. Including providers in the process improves the design of new CDS tools and can improve emotional responses to interruptive alerts, thus potentially contributing to decreased feelings of burnout.