{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T08:43:48Z","timestamp":1766738628912,"version":"3.37.3"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T00:00:00Z","timestamp":1652659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Doris Duke Charitable Foundation (DDCF","award":["2018093"],"award-info":[{"award-number":["2018093"]}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality (AHRQ","doi-asserted-by":"crossref","award":["1K08HS024764-01"],"award-info":[{"award-number":["1K08HS024764-01"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We developed a comprehensive, medication-related clinical decision support (CDS) software prototype for use in the operating room. The purpose of this study was to compare the usability of the CDS software to the current standard electronic health record (EHR) medication administration and documentation workflow.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>The primary outcome was the time taken to complete all simulation tasks. Secondary outcomes were the total number of mouse clicks and the total distance traveled on the screen in pixels. Forty participants were randomized and assigned to complete 7 simulation tasks in 1 of 2 groups: (1) the CDS group (n\u2009=\u200920), who completed tasks using the CDS and (2) the Control group (n\u2009=\u200920), who completed tasks using the standard medication workflow with retrospective manual documentation in our anesthesia information management system. Blinding was not possible. We video- and audio-recorded the participants to capture quantitative data (time on task, mouse clicks, and pixels traveled on the screen) and qualitative data (think-aloud verbalization).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The CDS group mean total task time (402.2\u2009\u00b1\u200985.9\u2009s) was less than the Control group (509.8\u2009\u00b1\u2009103.6\u2009s), with a mean difference of 107.6\u2009s (95% confidence interval [CI], 60.5\u2013179.5\u2009s, P\u2009&amp;lt;\u2009.001). The CDS group used fewer mouse clicks (26.4\u2009\u00b1\u20094.5 clicks) than the Control group (56.0\u2009\u00b1\u200915.0 clicks) with a mean difference of 29.6 clicks (95% CI, 23.2\u201337.6, P\u2009&amp;lt;\u2009.001). The CDS group had fewer pixels traveled on the computer monitor (59.5\u2009\u00b1\u200920.0 thousand pixels) than the Control group (109.3\u2009\u00b1\u200940.8 thousand pixels) with a mean difference of 49.8 thousand pixels (95% CI, 33.0\u201373.7, P\u2009&amp;lt;\u2009.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The perioperative medication-related CDS software prototype substantially outperformed standard EHR workflow by decreasing task time and improving efficiency and quality of care in a simulation setting.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocac035","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T20:10:26Z","timestamp":1646165426000},"page":"1416-1424","source":"Crossref","is-referenced-by-count":15,"title":["Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial"],"prefix":"10.1093","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1347-1640","authenticated-orcid":false,"given":"Karen C","family":"Nanji","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital , Boston, Massachusetts, USA"},{"name":"Harvard Medical School , Boston, Massachusetts, USA"},{"name":"Mass General Brigham, Inc. , Somerville, Massachusetts, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4346-7968","authenticated-orcid":false,"given":"Pamela M","family":"Garabedian","sequence":"additional","affiliation":[{"name":"Mass General Brigham, Inc. , Somerville, Massachusetts, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7614-5933","authenticated-orcid":false,"given":"Marin E","family":"Langlieb","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital , Boston, Massachusetts, USA"}]},{"given":"Angela","family":"Rui","sequence":"additional","affiliation":[{"name":"Mass General Brigham, Inc. , Somerville, Massachusetts, USA"}]},{"given":"Leo L","family":"Tabayoyong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Massachusetts General Hospital , Boston, Massachusetts, USA"}]},{"given":"Michael","family":"Sampson","sequence":"additional","affiliation":[{"name":"Learning Laboratory, Massachusetts General Hospital , Boston, Massachusetts, USA"}]},{"given":"Hao","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital , Boston, Massachusetts, USA"}]},{"given":"Aziz","family":"Boxwala","sequence":"additional","affiliation":[{"name":"Elimu Informatics, Inc. , La Jolla, California, USA"}]},{"given":"Rebecca D","family":"Minehart","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital , Boston, Massachusetts, USA"},{"name":"Harvard Medical School , Boston, Massachusetts, USA"},{"name":"Mass General Brigham, Inc. , Somerville, Massachusetts, USA"},{"name":"Learning Laboratory, Massachusetts General Hospital , Boston, Massachusetts, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6268-1540","authenticated-orcid":false,"given":"David W","family":"Bates","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, Massachusetts, USA"},{"name":"Mass General Brigham, Inc. , Somerville, Massachusetts, USA"},{"name":"Division of General Internal Medicine, Department of Medicine, Brigham and Women\u2019s Hospital , Boston, Massachusetts, USA"},{"name":"Department of Health Policy and Management, Harvard School of Public Health , Boston, Massachusetts, USA"}]}],"member":"286","published-online":{"date-parts":[[2022,5,16]]},"reference":[{"issue":"1","key":"2022071310033401800_ocac035-B1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/ALN.0000000000000904","article-title":"Evaluation of perioperative medication errors and adverse drug events","volume":"124","author":"Nanji","year":"2016","journal-title":"Anesthesiology"},{"key":"2022071310033401800_ocac035-B2","doi-asserted-by":"crossref","first-page":"d5543","DOI":"10.1136\/bmj.d5543","article-title":"Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomised clinical evaluation","volume":"343","author":"Merry","year":"2011","journal-title":"BMJ"},{"issue":"23","key":"2022071310033401800_ocac035-B3","doi-asserted-by":"crossref","first-page":"2314","DOI":"10.1093\/ajhp\/59.23.2314","article-title":"Observation method of detecting medication errors","volume":"59","author":"Barker","year":"2002","journal-title":"Am J Health Syst Pharm"},{"issue":"16","key":"2022071310033401800_ocac035-B4","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1001\/jama.285.16.2114","article-title":"Medication errors and adverse drug events in pediatric inpatients","volume":"285","author":"Kaushal","year":"2001","journal-title":"JAMA"},{"issue":"15","key":"2022071310033401800_ocac035-B5","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1001\/jama.279.15.1200","article-title":"Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies","volume":"279","author":"Lazarou","year":"1998","journal-title":"JAMA"},{"issue":"5","key":"2022071310033401800_ocac035-B6","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1136\/jamia.2009.001719","article-title":"Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects","volume":"17","author":"Magrabi","year":"2010","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"2022071310033401800_ocac035-B7","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1197\/jamia.M3285","article-title":"The impact of computerized provider order entry on medication errors in a multispecialty group practice","volume":"17","author":"Devine","year":"2010","journal-title":"J Am Med Inform Assoc"},{"issue":"9","key":"2022071310033401800_ocac035-B8","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1111\/j.1525-1497.2005.0194.x","article-title":"Outpatient prescribing errors and the impact of computerized prescribing","volume":"20","author":"Gandhi","year":"2005","journal-title":"J Gen Intern Med"},{"issue":"6","key":"2022071310033401800_ocac035-B9","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1136\/amiajnl-2011-000205","article-title":"Errors associated with outpatient computerized prescribing systems","volume":"18","author":"Nanji","year":"2011","journal-title":"J Am Med Inform Assoc"},{"issue":"16","key":"2022071310033401800_ocac035-B10","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1056\/NEJMsa020703","article-title":"Adverse drug events in ambulatory care","volume":"348","author":"Gandhi","year":"2003","journal-title":"N Engl J Med"},{"issue":"1","key":"2022071310033401800_ocac035-B11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/AAP.0b013e31823e75b2","article-title":"It is time to use checklists for anesthesia emergencies: simulation is the vehicle for testing and learning","volume":"37","author":"Nanji","year":"2012","journal-title":"Reg Anesth Pain Med"},{"year":"2019","key":"2022071310033401800_ocac035-B12"},{"issue":"2","key":"2022071310033401800_ocac035-B13","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/intqhc\/mzu010","article-title":"Standardization in patient safety: the WHO High 5s project","volume":"26","author":"Leotsakos","year":"2014","journal-title":"Int J Qual Health Care"},{"issue":"15","key":"2022071310033401800_ocac035-B14","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1001\/jama.280.15.1311","article-title":"Effect of computerized physician order entry and a team intervention on prevention of serious medication errors","volume":"280","author":"Bates","year":"1998","journal-title":"JAMA"},{"issue":"6","key":"2022071310033401800_ocac035-B15","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.ijmedinf.2007.10.001","article-title":"The impact of computerized physician medication order entry in hospitalized patients\u2013a systematic review","volume":"77","author":"Eslami","year":"2008","journal-title":"Int J Med Inform"},{"issue":"3","key":"2022071310033401800_ocac035-B16","doi-asserted-by":"crossref","first-page":"221","DOI":"10.2146\/ajhp110084","article-title":"Preventability of adverse drug events involving multiple drugs using publicly available clinical decision support tools","volume":"69","author":"Wright","year":"2012","journal-title":"Am J Health Syst Pharm"},{"issue":"10","key":"2022071310033401800_ocac035-B17","first-page":"e445","article-title":"Using electronic health record clinical decision support is associated with improved quality of care","volume":"20","author":"Mishuris","year":"2014","journal-title":"Am J Manag Care"},{"issue":"1","key":"2022071310033401800_ocac035-B18","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1136\/amiajnl-2011-000124","article-title":"Guided medication dosing for elderly emergency patients using real-time, computerized decision support","volume":"19","author":"Griffey","year":"2012","journal-title":"J Am Med Inform Assoc"},{"issue":"4","key":"2022071310033401800_ocac035-B19","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1542\/peds.2008-1494","article-title":"The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review","volume":"123","author":"van Rosse","year":"2009","journal-title":"Pediatrics"},{"issue":"5","key":"2022071310033401800_ocac035-B20","doi-asserted-by":"crossref","first-page":"e006539","DOI":"10.1136\/bmjopen-2014-006539","article-title":"Computerised clinical decision support systems to improve medication safety in long-term care homes: a systematic review","volume":"5","author":"Marasinghe","year":"2015","journal-title":"BMJ Open"},{"issue":"5","key":"2022071310033401800_ocac035-B21","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s10877-016-9921-x","article-title":"A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems","volume":"31","author":"Simpao","year":"2017","journal-title":"J Clin Monit Comput"},{"issue":"3","key":"2022071310033401800_ocac035-B22","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1053\/j.jvca.2017.11.002","article-title":"Perioperative information systems: opportunities to improve delivery of care and clinical outcomes in cardiac and vascular surgery","volume":"32","author":"Freundlich","year":"2018","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"6","key":"2022071310033401800_ocac035-B23","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1097\/ACO.0000000000000526","article-title":"Anesthesia information management: clinical decision support","volume":"30","author":"Freundlich","year":"2017","journal-title":"Curr Opin Anaesthesiol"},{"issue":"2","key":"2022071310033401800_ocac035-B24","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1213\/ANE.0000000000001636","article-title":"Intraoperative clinical decision support for anesthesia: a narrative review of available systems","volume":"124","author":"Nair","year":"2017","journal-title":"Anesth Analg"},{"key":"2022071310033401800_ocac035-B25","first-page":"365","volume-title":"Advances in Patient Safety: From Research to Implementation","author":"Rogers","year":"2005"},{"issue":"e2","key":"2022071310033401800_ocac035-B26","doi-asserted-by":"crossref","first-page":"e287\u201396","DOI":"10.1136\/amiajnl-2013-002045","article-title":"Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation","volume":"21","author":"Russ","year":"2014","journal-title":"J Am Med Inform Assoc"},{"issue":"5","key":"2022071310033401800_ocac035-B27","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1136\/jamia.2010.005264","article-title":"A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems","volume":"17","author":"Phansalkar","year":"2010","journal-title":"J Am Med Inform Assoc"},{"journal-title":"Appl Clin Inform","article-title":"Development of a perioperative medication-related clinical decision support tool to prevent medication errors: An analysis of user feedback","author":"Nanji","key":"2022071310033401800_ocac035-B28"},{"volume-title":"(NISTIR 7741) NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records","year":"2019","author":"Schumacher","key":"2022071310033401800_ocac035-B29"},{"key":"2022071310033401800_ocac035-B30","volume-title":"Cost-Justifying Usability: An Update for the Internet Age","author":"Bias","year":"2005","edition":"2nd ed."},{"year":"2018","key":"2022071310033401800_ocac035-B31"},{"issue":"3","key":"2022071310033401800_ocac035-B32","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.mayocp.2019.09.024","article-title":"The association between perceived electronic health record usability and professional burnout among US physicians","volume":"95","author":"Melnick","year":"2020","journal-title":"Mayo Clin Proc"},{"key":"2022071310033401800_ocac035-B33","first-page":"143","volume-title":"Human-Computer Interaction: Design and Evaluation","author":"Carter","year":"2015"},{"issue":"11\u201312","key":"2022071310033401800_ocac035-B34","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.ijmedinf.2004.08.003","article-title":"The think aloud method: a guide to user interface design","volume":"73","author":"Jaspers","year":"2004","journal-title":"Int J Med Inform"},{"key":"2022071310033401800_ocac035-B35","volume-title":"The Think Aloud Method: A Practical Guide to Modelling Cognitive Processes (Knowledge-Based Systems)","author":"Maarten van Someren","year":"1994","edition":"1st ed."},{"key":"2022071310033401800_ocac035-B36","first-page":"189","volume-title":"Usability Evaluation in Industry","author":"Brooke","year":"1996"},{"year":"2011","author":"Sauro","key":"2022071310033401800_ocac035-B37"},{"issue":"7","key":"2022071310033401800_ocac035-B38","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1080\/10447318.2018.1455307","article-title":"The system usability scale: past, present, and future","volume":"34","author":"Lewis","year":"2018","journal-title":"Int J Hum Coput Interact"},{"issue":"4","key":"2022071310033401800_ocac035-B39","doi-asserted-by":"crossref","first-page":"e13226","DOI":"10.2196\/13226","article-title":"A digital cognitive aid for anesthesia to support intraoperative crisis management: results of the user-centered design process","volume":"7","author":"Schild","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"issue":"25","key":"2022071310033401800_ocac035-B40","doi-asserted-by":"crossref","first-page":"3143","DOI":"10.1161\/circ.106.25.3143","article-title":"Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report","volume":"106","year":"2002","journal-title":"Circulation"},{"key":"2022071310033401800_ocac035-B41","volume-title":"Handbook of Usability Testing: How to Plan, Design and Conduct Effective Tests","author":"Rubin","year":"2008","edition":"2nd ed"},{"year":"2013","author":"Sauro","key":"2022071310033401800_ocac035-B42"},{"first-page":"1599","year":"2009","author":"Sauro","key":"2022071310033401800_ocac035-B43"},{"first-page":"1609","year":"2009","author":"Sauro","key":"2022071310033401800_ocac035-B44"},{"issue":"3","key":"2022071310033401800_ocac035-B45","first-page":"203","article-title":"A review of post-study and post-task subjective questionnaires to guide assessment of system usability","volume":"16","author":"Hodrien","year":"2021","journal-title":"J Usability Studies"},{"issue":"3","key":"2022071310033401800_ocac035-B46","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/ALN.0b013e3182a10e26","article-title":"Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension","volume":"119","author":"Walsh","year":"2013","journal-title":"Anesthesiology"},{"issue":"6","key":"2022071310033401800_ocac035-B47","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1097\/EJA.0000000000000429","article-title":"Intraoperative hypotension is associated with myocardial damage in noncardiac surgery: an observational study","volume":"33","author":"Hallqvist","year":"2016","journal-title":"Eur J Anaesthesiol"},{"issue":"4","key":"2022071310033401800_ocac035-B48","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/j.bja.2018.04.036","article-title":"Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review","volume":"121","author":"Wesselink","year":"2018","journal-title":"Br J Anaesth"},{"issue":"14","key":"2022071310033401800_ocac035-B49","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1001\/jama.2017.14172","article-title":"Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial","volume":"318","author":"Futier","year":"2017","journal-title":"JAMA"},{"key":"2022071310033401800_ocac035-B50","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jbi.2013.10.010","article-title":"Electronic health record acceptance by physicians: testing an integrated theoretical model","volume":"48","author":"Gagnon","year":"2014","journal-title":"J Biomed Inform"},{"issue":"2","key":"2022071310033401800_ocac035-B51","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/NCN.0b013e318224b54e","article-title":"Nursing satisfaction with implementation of electronic medication administration record","volume":"30","author":"Moreland","year":"2012","journal-title":"Comput Inform Nurs"},{"key":"2022071310033401800_ocac035-B52","volume-title":"Designing the User Interface: Strategies for Effective Human-Computer Interaction","author":"Shneiderman","year":"2016","edition":"6th edn"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/29\/8\/1416\/44829530\/ocac035.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/29\/8\/1416\/44829530\/ocac035.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T10:08:43Z","timestamp":1657706923000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/29\/8\/1416\/6585878"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,16]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,5,16]]},"published-print":{"date-parts":[[2022,7,12]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocac035","relation":{},"ISSN":["1527-974X"],"issn-type":[{"type":"electronic","value":"1527-974X"}],"subject":[],"published-other":{"date-parts":[[2022,8,1]]},"published":{"date-parts":[[2022,5,16]]}}}