Usability Testing


Usability testing is used to evaluate a product or service by testing it with its end user. It is designed to create a tool within the EMR that will provide a predictive value for a given pathology. This is particularly useful in cases where we create clinical decision support systems and observe the user using the tool before integration occurs. Usability testing allows the end user to use the tool before it is integrated into their workflow. This provides the observer an opportunity to to take notes on how the user is utilizing the tool and gain their feedback. It is understood that if the provider is able to use the tool with ease and have a basic understanding of it, they are more likely to adopt it. Tools like these have been built into the EMR for many years but have had limited success due to low provider adoption rates.


The Usability Lab developed a series of protocols for conducting usability testing on research versions of CDS software. Testing techniques included focus groups, interviews, think aloud testing, near live testing, and live testing. Each technique was designed to provide direct user feedback at different points in a CDS tool’s lifecycle, from the initial conceptual stage through the prototype stage through eventual launch in actual medical settings such as emergency departments and inpatient settings in hospitals. During usability testing, all interaction is captured including video and audio. The comments are recorded as they think aloud and are coded and categorized.


Providers responded positively to having the ability to use a tool in real clinical settings and being able to apply it to their patients. The implementation of usability testing has been used on all kinds of Clinical Decision Support tools that ranged from antibiotic prescribing and child abuse detection to the Wells CDSS for Pulmonary Embolism (PE) tool in emergency rooms and inpatient settings.  Providers appreciated the concise manner in which all the information was presented that was needed to complete the tool and reported increased efficiency in being able to complete the patient visit.


These usability-testing methods have proved to be useful when integrated properly with the CDS tool and allow us to refine the process. Usability testing allows for higher utilization rate if the user feels more comfortable with its use while the provider is comfortable if it aids in providing useful information while diagnosing, treating, discharging a patient. CDS usability testing can decrease the pressure on the providers on using the tool if they do not understand it or are aware of the benefits of it. However, if they are able to play a larger role in the creation of the tool they are most likely to adopt it in their daily workflow.