Table 3.

Usability recommendations with corresponding descriptions and representative quotations highlighted from usability testing with providers.

Recommendation	Description	Quotation
Format & Placement	Having both the BPA and in-basket alert formats embedded in the EHR would likely increase the probability of providers viewing the CDS	“And if you could somehow attach to the results in-basket that would allow us to see that alert at the same time that we’re seeing the result, which would be pretty awesome rather than having more in-baskets on it.”(PCP)
	Physicians indicated preference for the in-basket format linked to a lipid panel report
Content	Physicians highlighted the need for BPA and in-basket content to be more concise and clear	“There’s a lot of dense text. A lot of dense text…don’t be afraid of white space…and be telegraphic. So I would… critically looking at this message, I think I would look at individual words. This patient has an… those are not useful words yet. So LDL greater equal 190. That could be a line. Warning, possible familial hypercholesterolemia. Next line…Consider high-intensity… I wouldn’t even say high intensity… consider Rosuvastatin 20 or Atorvastatin 40 mg taken by mouth…Recommended laboratory testing could be another line.” (PCP)
	Only important information should be displayed
	Have few clicks to access knowledge resources and a relevant order set
	Have a reminder present to rule out secondary causes of hypercholesterolemia
Timing & Frequency	Have ‘reasons not to use’ at the end of the CDS so that providers can explain their decision to not act upon the alert	“…but if I’m done with it [in-basket message] or I feel like I’ve addressed it, maybe I’ve put in the orders for the FH Clinic, I’d like to get it out of there, because otherwise things get too cluttered, and I’ll get very frustrated if there’s no way to dismiss it and if it just stays there forever.” (Specialist)
	Viewing one alert should turn off all other alerts for the same provider
Prioritization	Most physicians described FH as being an important condition and agreed that color coding the CDS red would likely get their attention	“I think keep it red, because the people with this condition have significant events, and it’s something that you can prevent in their family members, so I would keep it red.”(Specialist)