Health information technology shows great promise for improving the efficiency, quality, and safety of medical care. Electronic health records (EHR) have the potential to facilitate patient care and benefit clinicians by improving access to information at various service points within the system. Computer provider order entry (CPOE) with clinical decision support tools
(CDST) has been shown to decrease medication ordering errors [1
]. There are several CDS tools such as: Computerized alerts and reminders, clinical guidelines, order sets, patient data reports and dashboards, documentation templates, diagnostic support, and clinical workflow tools.
CDST can provide support to clinicians at various stages in the care process, from preventive care through diagnosis and treatment to monitoring and follow-up, but results with CDST implementation have been mixed. CDSTs have been found to improve measures of clinician performance in the diagnosis [2
], prevention and management [4
] of a number of different health problems. CDST systems can improve clinical practice and prevent adverse drug events [5
]. Despite these benefits, there are many barriers to successful CDST implementation [6
]. Although several different CDSTs exist in health care, most have been unsuccessfully
implemented in clinical practice [6
]. In addition to intrinsic characteristics of the CDST, incorporation and integration in the clinical workflow remains one of the largest barriers to success [8
In this study we examine a CDST in family practices from a human factor perspective. We examine the need for a CDST to assess the risk of a cardiac event in the next 10 years; we assess the current use of such tools, and we examine barriers, barriers, and possible improvements to a specific tool, HeartDecision (HD), to assess cardiac risks.
HD is an easy to use online assessment tool, both in a stand-alone version and as part of an Electronic Health Record (EHR) system. The tool consists of 6 web pages: (1) Data Entry Page (automatically populated as part of the EHR); (2) a Risk Page that displays the risk of a cardiac event in the next 10 years; (3) a Goal Page that summarizes the specific risks (e.g. triglycerides are high) and possible causes for these risks (e.g. elevated triglycerides are associated with elevated body weight, a diet high in carbohydrates, including alcohol, and genetic disorders); (4) an Ideal Graph Page that graphically represents the risk in the next ten years that also allows for manipulation of several variables (e.g. blood pressure, triglycerides, etc.) that are used to calculate the risk; (5) a Hand Out Screen on which several hand-outs can be selected, such as information on fish oil capsules, etc, that can be printed out and handed to the patient, and (6) a Summary Page, that summarizes the information for patient and physician..