Formative assessment and design of a complex clinical decision support tool for pulmonary embolism.
Formative assessment and design of a complex clinical decision support tool for pulmonary embolism.
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DOI：
10.1136/ebmed-2015-110214
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发表时间：
2016-02-01
期刊：
影响因子：
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通讯作者：
McGinn, Thomas
中科院分区：
文献类型：
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作者：
Khan, Sundas;McCullagh, Lauren;McGinn, Thomas
基于电子健康记录（EHR）的临床决策支持（CDS）工具的推出迫切需要满足联邦要求，而没有时间进行可用性测试和用户界面的改进。作为为急诊医生设计、开发和集成肺栓塞CDS工具的更大项目的一部分，我们进行了形成性评估，以确定供应商对设计和内容的兴趣和投入程度。这是一项对急诊医学（EM）医生进行形成性评估的研究，包括焦点小组和关键知情人访谈。本研究的重点是双重的，以确定对CDS工具集成的一般态度和临床工作流程的理想集成点。为了实现这一目标，我们首先在一个焦点小组中接触EM医生，然后，在关键的线人访谈中，我们介绍了工作流程设计，并给出了一个场景，以帮助提供者可视化CDS工具的工作原理。参与者被问及有关触发位置，触发词，融入他们的工作流程，感知效用和启发的工具。参与者对触发地点、感知效用和效率的调查结果表明，提供者认为该工具与其说是一种帮助，不如说是一种障碍。然而，一些提供者评论说，他们没有接触过CDS工具，但使用过在线计算器，并认为如果将这些工具集成到EHR中，将有助于即时护理。此外，还有一个订单输入线框的偏好。本研究强调了设计CDS工具时需要考虑的几个因素：（1）EHR功能和临床环境工作流程的形成性评估，（2）焦点小组和关键信息访谈，以纳入供应商对CDS和工作流程集成的看法和/或（3）通过线框演示拟议的工作流程，以帮助供应商可视化设计概念。
Electronic health record (EHR)-based clinical decision support (CDS) tools are rolled out with the urgency to meet federal requirements without time for usability testing and refinement of the user interface. As part of a larger project to design, develop and integrate a pulmonary embolism CDS tool for emergency physicians, we conducted a formative assessment to determine providers' level of interest and input on designs and content. This was a study to conduct a formative assessment of emergency medicine (EM) physicians that included focus groups and key informant interviews. The focus of this study was twofold, to determine the general attitude towards CDS tool integration and the ideal integration point into the clinical workflow. To accomplish this, we first approached EM physicians in a focus group, then, during key informant interviews, we presented workflow designs and gave a scenario to help the providers visualise how the CDS tool works. Participants were asked questions regarding the trigger location, trigger words, integration into their workflow, perceived utility and heuristic of the tool. Results from the participants' survey responses to trigger location, perceived utility and efficiency, indicated that the providers felt the tool would be more of a hindrance than an aid. However, some providers commented that they had not had exposure to CDS tools but had used online calculators, and thought the tools would be helpful at the point-of-care if integrated into the EHR. Furthermore, there was a preference for an order entry wireframe. This study highlights several factors to consider when designing CDS tools: (1) formative assessment of EHR functionality and clinical environment workflow, (2) focus groups and key informative interviews to incorporate providers' perceptions of CDS and workflow integration and/or (3) the demonstration of proposed workflows through wireframes to help providers visualise design concepts.