Table 1:

Usability Problems Identified During Heuristic Evaluation Session

Problem	Heuristic(s) Violated	Barriers/Limitations	Solution
User Interface Design
Should always be an “active” (pop-up) alert	Visibility, Consistency, Match	Only certain trigger patterns result in active alerts; Otherwise passively displayed on screen	Discuss alternative solutions with EHR programmers Request changes in future system updates to support active alerts
Have to scroll up to see alert once triggered	Visibility	Dependent upon screen placement of triggering action	Move location of alert on screen to appear near triggering action
“High Risk Falls” banner has same placement and color as nurse flow sheet evaluation for falls; Confusing for users.	Consistency Visibility Language Match	Can’t change the color or language of nurse alert (already part of clinical practice)	Change color of our banner Change banner language to “Consider Referral to Falls Clinic” Move alert to right column, away from nurse fall-risk alert; Placed with “Follow Up” and “Instructions”
“Follow-Up Actions” button location is not intuitive or easy to find; Should be closer to instructions	Visibility Match Control	Can’t move button or generate alternative way to access order screen	Unable to change
“Acknowledge Reason” button is not relevant	Match	Patients not consulted prior to order placement	Remove “Patient Declines Referral” button Add “Other” button instead
Placement of “Consult to…” language next to “Do Not Order” is confusing	Match Consistency	Placement can’t be changed and is what ED providers are used to seeing	Unable to change
Functionality
Alert fires only after final diagnosis and disposition have been entered, requiring screen refresh	Match Feedback Visibility	Fall risk algorithm currently requires final ED diagnosis to calculate score	Revise algorithm to reliably assess fall risk without using final ED diagnosis as a factor
No feedback telling providers that the order was successfully generated	Feedback Closure	System does not generate feedback upon placement of orders	Unable to change Providers don’t expect automatic feedback following order placement
Content
Too much text on alert screen	Minimalist Language	Must include all information for both initial alert and Follow-Up Actions screen	Simplify language Use bullet points rather than longer sentences
Clicking “Follow-Up Actions” should bring up list of action steps, not same content as initial alert	Match Language Feedback	System requires the exact same text on the initial alert and “Follow-Up Actions” screen	Unable to change prior to initial launch
Action steps do not include communicating about order with patient	Control Prevent Errors	None	Add bullet item: “Discuss this order with the patient and/or caregiver”
No easy way to access to supporting documentation from the alert screen	Documentation Memory Load	None	Add link to intranet page containing: Falls Clinic information Guide for communicating with patients about falls risk assessment FAQs for providers answering patient questions