Effect of CPOE User Interface Design on User-Initiated Access to Educational and Patient Information during Clinical Care
- S Trent Rosenbloom,
- Antoine J Geissbuhler,
- William D Dupont,
- Dario A Giuse,
- Douglas A Talbert,
- William M Tierney,
- W Dale Plummer,
- William W Stead,
- Randolph A Miller
- Affiliations of the authors: Departments of Biomedical Informatics (STR, DAG, DAT, WWS, RAM), Internal Medicine (STR, WWS, RAM), and Biostatistics (WDD, WDP), School of Nursing (STR), Vanderbilt University, Nashville, TN; Division of Medical Informatics, Geneva University Hospitals, Geneva, Switzerland (AJG); Tennessee Technological University, Cookeville, TN (DAT); Regenstrief Institute, Inc., Indiana University, Indianapolis, IN (WMT)
- Correspondence and reprints: S. Trent Rosenbloom, MD, MPH, Eskind Biomedical Library, Room 440, 2209 Garland Avenue, Nashville, TN 37232-8340; e-mail: <trent.rosenbloom{at}vanderbilt.edu>
- Received 1 June 2004
- Accepted 16 February 2005
Abstract
Objective Authors evaluated whether displaying context sensitive links to infrequently accessed educational materials and patient information via the user interface of an inpatient computerized care provider order entry (CPOE) system would affect access rates to the materials.
Design The CPOE of Vanderbilt University Hospital (VUH) included “baseline” clinical decision support advice for safety and quality. Authors augmented this with seven new primarily educational decision support features. A prospective, randomized, controlled trial compared clinicians' utilization rates for the new materials via two interfaces. Control subjects could access study-related decision support from a menu in the standard CPOE interface. Intervention subjects received active notification when study-related decision support was available through context sensitive, visibly highlighted, selectable hyperlinks.
Measurements Rates of opportunities to access and utilization of study-related decision support materials from April 1999 through March 2000 on seven VUH Internal Medicine wards.
Results During 4,466 intervention subject-days, there were 240,504 (53.9/subject-day) opportunities for study-related decision support, while during 3,397 control subject-days, there were 178,235 (52.5/subject-day) opportunities for such decision support, respectively (p = 0.11). Individual intervention subjects accessed the decision support features at least once on 3.8% of subject-days logged on (278 responses); controls accessed it at least once on 0.6% of subject-days (18 responses), with a response rate ratio adjusted for decision support frequency of 9.17 (95% confidence interval 4.6–18, p < 0.0005). On average, intervention subjects accessed study-related decision support materials once every 16 days individually and once every 1.26 days in aggregate.
Conclusion Highlighting availability of context-sensitive educational materials and patient information through visible hyperlinks significantly increased utilization rates for study-related decision support when compared to “standard” VUH CPOE methods, although absolute response rates were low.
Footnotes
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Supported by U.S. National Library of Medicine Grants (R01 LM06226-01 and 5 T15 LM007450-02), by the Vanderbilt Physician Scientist Development program, and by Vanderbilt University Medical Center funds.
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Note: The Quick Medical Reference (QMR)® knowledgebase is ©1994 by the University of Pittsburgh and is proprietary to that institution. It has been supplied to Vanderbilt University for purposes of research.
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Disclosure: The WizOrder Care Provider Order Entry system described in this article was developed by Vanderbilt University Medical Center faculty and staff within the School of Medicine and Informatics Center beginning in 1994. In May 2001, Vanderbilt University licensed the product to a commercial vendor, who is modifying the software. All study data were collected before the commercialization agreement, and the system as described represents the Vanderbilt noncommercialized software code. Dr. S. Trent Rosenbloom, the lead author, has been paid by the commercial vendor in the past to demonstrate the noncommercialized Vanderbilt product to potential clients. Drs. Geissbuhler, Giuse, Miller, Stead, and Talbert have been recognized by Vanderbilt as contributing to the authorship of the WizOrder software and have received and will continue to receive royalties from Vanderbilt under the University's intellectual property policies. While these involvements could potentially be viewed as a conflict of interest with respect to the submitted article, the authors have taken a number of concerted steps to avoid an actual conflict (including conduct of study design and statistical analysis by individuals not involved in software development or commercialization), and those steps have been disclosed to the Journal during editorial review.
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The authors thank Jonathan Grande, Douglas Kernodle, and Matt Steidel, VUMC Internal Medicine Chief Residents, and the VUH Medical House Officers for their significant contributions to the project and Elizabeth Madsen for her assistance in proofreading the manuscript.
