Background and importance User interface design features, such as screen layout, density of information, position of messages and use of colour, may affect the usability of electronic prescribing (EP) systems, with usability problems previously associated with medication errors.

Aim and objectives To explore users’ perspectives of the on-screen design features of a commercially available EP system and how these are perceived to affect patient safety.

Material and methods The study was conducted at a large London teaching hospital during 2018–2019. Participants were recruited via adverts on the intranet; all prescribers with experience using the EP system were eligible to participate. We used a mixed qualitative approach. First, prescribers were asked to conduct a prescribing task for a simulated patient using a think aloud approach. Second, we conducted a semi-structured interview with each participant to explore their views in more detail, with a focus on patient safety. Interview questions were developed based on the literature and then piloted. Think aloud and interview transcripts were analysed inductively using a thematic approach. Ethics approval was obtained.

Results Ten participants took part (three registrars, three foundation year 1 doctors, two foundation year 2 doctors and two pharmacist prescribers). Key themes from the think aloud and interview transcripts included: (1) EP design features and process flow; (2) benefits of EP systems; and (3) suggestions for improvement. For instance, design features such as screen features and layout were discussed with regards to impact on workflow, as well as ‘information overload’. Suggestions for improvement were made in relation to embedding trust guidelines and making changes to system design (eg, colour, fonts, customisation) to increase information visibility and enhance overall attention. Lastly, a need was expressed for better support for interacting with patients while using the system, as well as making drug–drug interaction alerts more targeted to support medication safety while also avoiding alert fatigue.

Conclusion and relevance We identified specific interface design factors that may improve the usability and/or safety of EP systems, which can be used to inform future experimental research in this area. Limitations include the small sample size; further work should include similar studies on other EP systems.

Conflict of interest Corporate sponsored research or other substantive relationships: I supervise a PhD student who is partly funded by a supplier of a commercial electronic prescribing system.