Applying User-Centered Design to Develop a Prescriber Feedback Tool in Acute Outpatient Care Settings at the Veterans Health Administration

OBJECTIVE: Acute care providers lack an easy way to assess their prescribing practices and track future related care for their patients. Thus, we conducted design evaluations and subject matter expert (SME) design sessions in a user-centered design (UCD) approach to develop an audit and feedback tool that provides individualized, scalable prescribing feedback to clinical providers about their antibiotic and nonsteroidal anti-inflammatory drug (NSAID) prescriptions in unplanned care settings (e.g., emergency department and urgent primary care). MATERIALS AND METHODS: A UCD approach was conducted with 11 individual interviews through two rounds of formative testing focusing on interface design efficiency, effectiveness, and visualization interpretability. We conducted several design sessions with SMEs, prescribers in emergency and primary care medicine, where the design team asked the SMEs to comment and do a walk-through with various design prototypes for the tool and then further iterate new designs. Feedback about different user interface designs was obtained from future tool users in usability evaluation sessions where a provider interacted with the prototype through think-aloud guided by a semi-structured interview outline. RESULTS: Through two rounds of usability evaluations, key usability issues were identified with the navigation, language, and interpretation of the data presented. This led to substantial interface design changes prior to implementation that improved usability and usefulness as evidenced by a decrease in the number of usability issues found during the second round of evaluation. DISCUSSION: Participants appreciated the concept and usefulness of the tool presented; however, during usability sessions, they identified important optimizations, clarifications, and changes for improvement. CONCLUSION: Key generalizable findings include user preferences for non-judgmental framing of prescribing, and desire for intuitive presentation and summarization of recent care delivered to support actionable feedback. Required changes during UCD underscore the importance of this type of usability evaluations during tool ideation and development.