{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T01:23:31Z","timestamp":1772760211791,"version":"3.50.1"},"reference-count":60,"publisher":"Georg Thieme Verlag KG","issue":"01","funder":[{"name":"U.S. Department of Health and Human Services, U.S. Public Health Service, Agency for Healthcare Research and Quality","award":["R18 HS028955"],"award-info":[{"award-number":["R18 HS028955"]}]},{"name":"U.S. Department of Health and Human Services, National Institutes of Health, National Institute of General Medical Science of the National Institutes of Health","award":["T32 GM135094"],"award-info":[{"award-number":["T32 GM135094"]}]},{"name":"U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute","award":["T32 HL170986"],"award-info":[{"award-number":["T32 HL170986"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Deviation from evidence-based guidelines is common and associated with worse patient outcomes, especially in hectic emergency departments (EDs). Clinical decision support (CDS) systems can improve outcomes by promoting guideline adherence while allowing patient-specific adaptation. Implementation of a CDS system for pneumonia (\u201cePneumonia\u201d) in the ED has been associated with improved guideline adherence and reduced 30-day mortality. However, adoption of ePneumonia has been hindered by a suboptimal user interface (UI).<\/jats:p>\n                  <jats:p>This study aimed to redesign the ePneumonia UI to improve usability and adoption.<\/jats:p>\n                  <jats:p>We conducted a user-centered design study involving ED clinicians at Vanderbilt University Medical Center. Across two rounds of one-on-one usability interviews with ED clinicians held via videoconference we (1) identified user requirements, and (2) iteratively refined a UI prototype. During each usability interview we presented realistic pneumonia cases, observed the clinician interact with a prototype, and elicited feedback with a semi-structured interview guide. We applied rapid thematic analysis and iteratively updated ePneumonia UI prototypes between interviews.<\/jats:p>\n                  <jats:p>Among 21 invited ED clinicians, 19 (90%) participated, including 15 attendings, 3 residents, and 1 advanced practice provider; 6 (32%) participants were women. Initial findings revealed that the original step-by-step UI did not align with the dynamic ED workflow. Clinicians expressed a need for both flexibility (e.g., skipping sections, overriding recommendations) and constraints (e.g., alerts for guideline deviations). We identified UI features to meet these needs that resulted in greater subjective usability including: a three-step navigation scheme, tiered information display, and multimodal indicators (text, icon, color) of agreement between clinician choices and CDS recommendations.<\/jats:p>\n                  <jats:p>A user-centered design approach identified UI features that were associated with greater perceived usability of a CDS for pneumonia in the ED. Future work will evaluate real-world usability and adoption in a clinical trial.<\/jats:p>","DOI":"10.1055\/a-2808-9190","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T02:17:58Z","timestamp":1772245078000},"page":"089-098","source":"Crossref","is-referenced-by-count":0,"title":["User-Centered Redesign of a Clinical Decision Support System for Pneumonia in the Emergency Department"],"prefix":"10.1055","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6021-8680","authenticated-orcid":false,"given":"Matthew A.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russ","family":"Beebe","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States"},{"name":"Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, Vanderbilt University, Nashville, Tennessee, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie","family":"Reale","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States"},{"name":"Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janelle","family":"Faiman","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United 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M.","family":"Slagle","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asli O.","family":"Weitkamp","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett A.","family":"Nance","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Intermountain Health Bear River Valley Hospital, Tremonton, Utah, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn G.","family":"Kuttler","sequence":"additional","affiliation":[{"name":"Department of Advanced Decision Support, Informatics, Intermountain Health, Salt Lake City, Utah, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason R.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States"},{"name":"Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ithan D.","family":"Peltan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States"},{"name":"Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States"},{"name":"Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan C.","family":"Dean","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States"},{"name":"Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shilo","family":"Anders","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States"},{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States"},{"name":"Geriatric Research, Education, and Clinical Center, Tennessee Valley Health Care, Veterans Health Administration, Nashville, Tennessee, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"26","key":"ref1","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1056\/NEJMsa022615","article-title":"The quality of health care delivered to adults in the United States","volume":"348","author":"E A McGlynn","year":"2003","journal-title":"N Engl J 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