Electronic health record usability for management of actionable incidental imaging findings: A survey of primary care providers

Actionable incidental imaging findings (AIF) are present in up to one-third of radiology reports and are uniquely challenging for primary care physicians (PCP) to manage. Appropriate imaging follow-up remains suboptimal at many sites. This study surveyed PCPs at a multi-site academic institution about the perceived usability of and preferences between three electronic health record (EHR) based AIF follow-up systems for incidental pulmonary nodules. The three options were Best Practice Advisory (BPA; pop-up), message, and dashboard. BPA and message are considered knowledge push options (system-initiated) and dashboard is knowledge pull (user-initiated). PCPs were asked to fill out the system usability scale (SUS) for each option and rank the options on personal preference. Sixty-two PCPs responded (29.2%): 37 attending physicians and 25 advanced practice providers. The message option was most preferred (56.7% first choice), followed by BPA (35.3% first choice), and then dashboard (8% first choice). The BPA and message options had higher reported usability than the dashboard (SUS [mean ± STD]: BPA 66.6 ± 21.5, message 66.3 ± 23.2, dashboard 41.0 ± 21.6; p < 0.001). The BPA and message options were rated near average usability (average SUS=68), while the dashboard was rated below the bad usability threshold (SUS <50). These usability scores are lower than previously reported EHR usability, which may reflect the increased clinical complexity of AIF follow-up. Overall, PCPs prefer knowledge push over knowledge pull options for AIF follow-up systems.