The design of decisions: Matching clinical decision support recommendations to Nielsen's design heuristics

Objective: While general design heuristics exist for graphic user interfaces, it remains a challenge to facilitate the implementation of these heuristics for the design of clinical decision support. Our goals were to map a set of recommendations for clinical decision support design found in current literature to Jakob Nielsen's traditional usability heuristics and to suggest usability areas that need more investigation. Materials and methods: Using a modified nominal group process, the research team discussed, classified, and mapped recommendations, organized as interface, information, and interaction, to design heuristics. A previous narrative review identified 42 recommendations from the literature to define the design and functional characteristics that impact the performance of CDS in terms of provider preference, process of care, and patient outcomes. Main findings: We matched 20 out of 42 recommendations to heuristics. The mapping reveals gaps in both heuristics and recommendations, identifying a set of Nielsen's heuristics that are underrepresented in the literature and subsets of recommendations important to design not covered in Nielsen's heuristics. We attributed this, in part, to the evolution of technology since the inception of Nielsen's heuristics. The team created a new interaction heuristic: Integration into real-time workflow to consider the needs of the end-user in the clinical space. Discussion: Clinical decision support has enabled clinicians to better address arising information needs; however there remains a lack of evidence-based guidelines in terms of functional and design requirements. Conclusion: Results from this review suggest that interaction design principles were not fully satisfied by the current literature of clinical decision support.