Abstract
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 is 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 health care 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 a 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.