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Effect of CPOE User Interface Design on User-Initiated Access to Educational and Patient Information during Clinical Care

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 for publication: 06/01/04; accepted for publication: 02/16/05.

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.

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