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Table 4 User feedback on the alerts during individual think-aloud sessions

From: Human-centered design of clinical decision support for management of hypertension with chronic kidney disease

Finding

Quotations

Users disagreed with recommended clinical actions

“The only thing I might change is I might start with a lower dose, and just up-titrate the losartan from there”

“Need to increase that lisinopril. I've already discussed that. I frankly would go up by more than just 10.”

Users had concerns about the alert placement within their workflow and ability to navigate to other parts of the chart

“So, the problem I would have with this right now is that I haven’t talked to the patient, and it would be inappropriate for me to start a new medication without discussing with the patient”

Users requested additional clinical information

“I’d love to know what his potassium is before I start the lisinopril. If I had access to that, that would be great.”

“It's also the most recent eGFR. It would be interesting to have the date here.”

Users had difficulty understanding the behavior of the Acknowledge Reasons and how they behaved in relation to the Order buttons

“Then I have to acknowledge a reason if I don’t accept it? I’m just curious how this works again.”

Users did not have consensus on informing patients about CKD and BP in their after-visit summary

“I think it would just scare patients like, “I don’t know. You didn’t tell me I had kidney disease today.”

Users had some difficulty understanding the Order buttons (3)

“I did see [the order options], but they were highlighted as do not order, so I had assumed [they were not recommended]”

Users noted that the medication order screen does not allow modification to an existing order

“It would be nice if this could program a change [of dose] instead of a new prescription so that I didn't have to discontinue.”