  OBJECTIVE: To design and evaluate new pharmacogenomic (PGx) clinical decision
support (CDS) alerts, built to adhere to PGx CDS design principles developed
through socio-technical approaches.
  MATERIALS AND METHODS: Based on previously identified design principles, we
created 11 new PGx CDS alert designs and developed an interactive web
application containing realistic clinical scenarios and user workflows that
mimicked a real-world EHR system. We recruited General Internal Medicine and
Cardiology clinicians from Northwestern Medicine and recorded their
interactions with the original and new designs. We measured clinician response,
satisfaction, speed, and confidence through questionnaires and analysis of the
recordings.
  RESULTS: The study included 12 clinicians. Participants were significantly
more satisfied (p=0.0000001), faster (p=0.009), and more confident (p<.05) with
the new designs than the original ones. The study lacked statistical power to
determine whether prescribing accuracy was improved, but participants were no
less accurate, and clinical actions were more concordant with alert
interactions (p=0.004) with the new designs. We found a significant learning
curve associated with the original designs, which was eliminated with the new
designs.
  DISCUSSION: This study successfully demonstrates that socio-technical and
user-centered design techniques can improve PGx CDS alert designs. Best
practices for PGx CDS design are limited in the literature, with few
effectiveness studies available. These results can help guide future PGx CDS
implementations to be more clinician friendly and less time-consuming.
  CONCLUSION: The results of this study support the PGx CDS design principles
we proposed in previous work. As a next step, the new designs should be
implemented in a live setting for further validation.
