Improving the usability and usefulness of computerized decision support systems for medication review by clinical pharmacists: A convergent, parallel evaluation

Background: Computerized decision support systems (CDSSs) help hospital-based clinical pharmacists to perform medication reviews and so are promising tools for improving medication safety. However, their poor usability can reduce effectiveness and acceptability.

Objectives: To evaluate the usability and perceived usefulness of a CDSS for medication review by hospital-based pharmacists and to draw up guidelines on improving its usability.

Methods: We performed a convergent, parallel evaluation. Firstly, three researchers conducted a heuristic evaluation of the CDSS. Secondly, clinical pharmacists who use the CDSS filled out the Usefulness, Satisfaction and Ease of Use (USE) questionnaire. Lastly, semi-structured interviews with the pharmacists enabled us to understand their opinions and experiences. The results of the heuristic evaluation were used to identify potential improvements in the CDSS. We performed a statistical analysis of the USE questionnaire data. Interviews were analyzed based on the unified theory of acceptance and use of technology (UTAUT), together with a task-technology fit model. The results generated by these three approaches were compared in order to determine convergences and divergences, identify challenges related to the usability and usefulness of the CDSS, and draw up guidelines for its improvement.

Results: Forty-seven usability problems were discovered; they variously concerned the graphical user interface, the pharmacists' needs, and the medication review model implemented in the CDSS. Only the "usefulness" dimension of the USE was not scored positively. All the UTAUT dimensions and the task-technology fit dimension emerged in the interviews. Cross-comparisons of the results from the three approaches led to the identification of four challenges and the corresponding formulation of 23 guidelines.

Conclusions: The guidelines developed here should help to improve the design and acceptability of CDSSs. Hence, CDSSs will be able to assist clinical pharmacists more fully with their medication reviews and help to further improve patient safety.