J Am Med Inform Assoc doi:10.1136/amiajnl-2013-002045
  • Research and applications

Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation

  1. Jason J Saleem14
  1. 1Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, Department of Veterans Affairs, Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
  2. 2Indiana University Center for Health Services and Outcomes Research and Regenstrief Institute, Inc., Indianapolis, Indiana, USA
  3. 3College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
  4. 4School of Pharmacy, University of Kansas, Lawrence, Kansas, USA
  5. 5Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
  6. 6David Geffen School of Medicine, University of California, Los Angeles, California, USA
  7. 7Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
  8. 8Department of Psychology, Purdue University, West Lafayette, Indiana, USA
  9. 9Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
  10. 10Department of Nephrology Services, Department of Veterans Affairs, Temple, Texas, USA
  11. 11Department of Veterans Affairs, Office of Information, Bay Pines, Florida, USA
  12. 12Department of Veterans Affairs, Office of Information, Salt Lake City, Utah, USA
  13. 13Department of BioHealth Informatics, School of Informatics and Computing, Indiana University-Purdue University, Indianapolis, Indiana, USA
  14. 14Human Factors Engineering, Office of Informatics and Analytics, Veterans Health Administration, Louisville, Kentucky, USA
  1. Correspondence to Dr Alissa L Russ, Richard L. Roudebush VA Medical Center, 1481 W. 10th St., 11-H, Indianapolis, IN 46202, USA; alissa.russ{at}
  • Received 30 May 2013
  • Revised 21 January 2014
  • Accepted 26 February 2014
  • Published Online First 25 March 2014


Objective To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors.

Materials and methods We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug–allergy, drug–drug interaction, and drug–disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors.

Results Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1–5) compared to original alerts: 4 (1–7); p=0.024).

Discussion Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts.

Conclusions This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes.

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