Realizing the Full Potential of Clinical Decision Support: Translating Usability Testing into Routine Practice in healthcare operations.

Background: Clinical Decision Support (CDS) tools have a mixed record of effectiveness, often due to inadequate alignment with clinical workflows and poor usability. While there's a consensus that usability testing methods address these issues, in practice, usability testing is generally only used for selected projects (such as funded research studies). There is a critical need for CDS operations to apply usability testing to all CDS implementations.

Objectives: In this State of the Art / Best Practice paper, we share challenges with scaling usability in healthcare operations and alternative methods and CDS governance structures to enable usability testing as a routine practice.

Methods: We coalesce our experience and results of applying guerilla in-situ usability testing to over 20 projects in 1 year period with the proposed solution.

Results: We demonstrate the feasibility of adopting "guerilla in-situ usability testing" in operations and their effectiveness in incorporating user feedback and improving design.

Conclusion: Although some methodological rigor was relaxed to accommodate operational speed, the benefits outweighed the limitations. Broader adoption of usability testing may transform CDS implementation and improve health outcomes.