scholarly journals A thematic analysis to examine the feasibility of EHR-based clinical decision support for implementing Choosing Wisely® guidelines

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Brian J Douthit ◽  
Catherine J Staes ◽  
Guilherme Del Fiol ◽  
Rachel L Richesson
Keyword(s):  
Decision Support ◽  
Data Quality ◽  
Clinical Decision Support ◽  
Thematic Analysis ◽  
Clinical Decision ◽  
Choosing Wisely ◽  
Complex Nature ◽  
Individual Level ◽  
Qualitative Thematic Analysis ◽  
Implementation Planning

Abstract Objective To identify important barriers and facilitators relating to the feasibility of implementing clinical practice guidelines (CPGs) as clinical decision support (CDS). Materials and Methods We conducted a qualitative, thematic analysis of interviews from seven interviews with dyads (one clinical expert and one systems analyst) who discussed the feasibility of implementing 10 Choosing Wisely® guidelines at their institutions. We conducted a content analysis to extract salient themes describing facilitators, challenges, and other feasibility considerations regarding implementing CPGs as CDS. Results We identified five themes: concern about data quality impacts implementation planning; the availability of data in a computable format is a primary factor for implementation feasibility; customized strategies are needed to mitigate uncertainty and ambiguity when translating CPGs to an electronic health record-based tool; misalignment of expected CDS with pre-existing clinical workflows impact implementation; and individual level factors of end-users must be considered when selecting and implementing CDS tools. Discussion The themes reveal several considerations for CPG as CDS implementations regarding data quality, knowledge representation, and sociotechnical issues. Guideline authors should be aware that using CDS to implement CPGs is becoming increasingly popular and should consider providing clear guidelines to aid implementation. The complex nature of CPG as CDS implementation necessitates a unified effort to overcome these challenges. Conclusion Our analysis highlights the importance of cooperation and co-development of standards, strategies, and infrastructure to address the difficulties of implementing CPGs as CDS. The complex interactions between the concepts revealed in the interviews necessitates the need that such work should not be conducted in silos. We also implore that implementers disseminate their experiences.

scholarly journals Accompanying the Prostate Cancer Patient Pathway: Evaluation of Novel Clinical Decision Support Software

2021 ◽  
Author(s):  
Maurice Henkel ◽  
Tobias Horn ◽  
Francois Leboutte ◽  
Pawel Trotsenko ◽  
Sarah G. Dugas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Decision Support ◽  
Information Systems ◽  
Data Quality ◽  
Clinical Decision Support ◽  
User Satisfaction ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Process

Abstract Introduction Physicians spend more than half of their workday interacting with health information systems to care for their patients. Effective data management that provides physicians with comprehensive patient information from various information systems is required to ensure high quality clinical decision making.Objectives We evaluated the impact of a novel, CE-certified clinical decision support tool on physician’s effectiveness and satisfaction in the clinical decision-making process.Methods Using pre-therapeutic prostate cancer management cases, we compared physician’s expenditure of time, data quality, and user satisfaction in the decision-making process comparing the current standard with the software. Ten urologists from our department conducted the diagnostic work-up to the treatment decision for a total of 10 patients using both approaches.Results A significant reduction in the physician’s expenditure of time for the decision-making process by -59.9 % (p < 0,001) was found using the software. System usage showed a high positive effect on evaluated data quality parameters completeness (Cohen's d of 2.36), format (6.15), understandability (2.64), as well as user satisfaction (4.94).Conclusion The software demonstrated that effective data management can improve physician’s effectiveness and satisfaction in the clinical decision-making process. Further development is needed to map more complex patient pathways, such as the follow-up treatment of prostate cancer.

scholarly journals Electronic Clinical Decision Support for Children with Minor Head Trauma and Intracranial Injuries: A Sociotechnical Analysis

2020 ◽  
Author(s):  
Jacob K Greenberg ◽  
Ayodamola Otun ◽  
Azzah Nasraddin ◽  
Ross C Brownson ◽  
Nathan Kuppermann ◽  
...  
Keyword(s):  
Information Technology ◽  
Decision Support ◽  
Focus Group ◽  
Clinical Decision Support ◽  
Thematic Analysis ◽  
Clinical Decision ◽  
Evidence Based ◽  
Minor Head Trauma ◽  
Technology Specialists ◽  
Electronic Clinical Decision Support

Abstract Background: Current management of children with minor head trauma (MHT) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) for management of these children may improve patient safety and decrease resource use. To guide these efforts, we evaluated the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure, among other factors. Methods: Between March and May, 2020 semi-structured qualitative focus group interviews were conducted to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine health centers in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were then cross-referenced with previously defined sociotechnical dimensions.Results: We included 28 physicians and four information technology specialists in seven focus groups (median five participants per group). Five physicians were trainees and 10 had administrative leadership positions. Through inductive thematic analysis, we identified five primary themes: 1) clinical impact; 2) stakeholders and users; 3) tool content; 4) clinical practice integration; and 5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children. However, some had mixed feelings regarding how the tool could best be used by different specialties (e.g. use by neurosurgeons versus non-neurosurgeons). Feedback from the interviews helped refine the tool content and also highlighted potential technical and workflow barriers to address prior to implementation. Conclusions: We identified key factors impacting the implementation of electronic CDS for children with MHT and intracranial injuries. These results have informed our implementation strategy and may also serve as a template for future efforts to implement health information technology in a multidisciplinary, emergency setting.

scholarly journals Mobile phone apps for clinical decision support in pregnancy: a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jenny Carter ◽  
Jane Sandall ◽  
Andrew H. Shennan ◽  
Rachel M. Tribe
Keyword(s):  
Decision Support ◽  
Mobile Phone ◽  
Clinical Decision Support ◽  
Thematic Analysis ◽  
Scoping Review ◽  
Mobile Apps ◽  
Clinical Decision ◽  
Ease Of Use ◽  
Barriers To Implementation ◽  
In Pregnancy

Abstract Background The use of digital technology in healthcare has been found to be useful for data collection, provision of health information and communications. Despite increasing use of medical mobile phone applications (apps), by both clinicians and patients, there appears to be a paucity of peer-reviewed publications evaluating their use, particularly in pregnancy. This scoping review explored the use of mobile phone apps for clinical decision support in pregnancy. Specific objectives were to: 1. determine the current landscape of mobile phone app use for clinical decision support in pregnancy; 2. identify perceived benefits and potential hazards of use and 3. identify facilitators and barriers to implementation of these apps into clinical practice. Methods Papers eligible for inclusion were primary research or reports on the development and evaluation of apps for use by clinicians for decision support in pregnancy, published in peer-reviewed journals. Research databases included Medline, Embase, PsychoInfo, the Cochrane Database of Systematic Reviews and the online digital health journals JMIR mHealth and uHealth. Charting and thematic analysis was undertaken using NVivo qualitative data management software and the Framework approach. Results After screening for eligibility, 13 papers were identified, mainly reporting early stage development of the mobile app, and feasibility or acceptability studies designed to inform further development. Thematic analysis revealed four main themes across the included papers: 1. acceptability and satisfaction; 2. ease of use and portability; 3. multi-functionality and 4. the importance of user involvement in development and evaluation. Conclusions This review highlights the benefits of mobile apps for clinical decision support in pregnancy and potential barriers to implementation, but reveals a lack of rigorous reporting of evaluation of their use and data security. This situation may change, however, following the issue of FDA and MHRA guidelines and implementation of UK government and other international strategies. Overall, the findings suggest that ease of use, portability and multi-functionality make mobile apps for clinical decision support in pregnancy useful and acceptable tools for clinicians.

scholarly journals Interventions to improve the use of EMRs in primary health care: a systematic review and meta-analysis

2019 ◽  
Vol 26 (1) ◽  
pp. e000023
Author(s):  
Noura Hamade ◽  
Amanda Terry ◽  
Monali Malvankar-Mehta
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Data Quality ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Primary Healthcare ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Healthcare Settings

BackgroundElectronic medical record (EMR) adoption in primary care has grown exponentially since their introduction in the 1970s. However, without their proper use benefits cannot be achieved. This includes: 1) the complete and safe documentation of patient information; 2) improved coordination of care; 3) reduced errors and 4) more involved patients. The use of EMRs is defined by practitioners using EMRs and their features to perform daily practice functions.ObjectiveThe purpose of this systematic review was to identify interventions aimed at improving EMR use in primary healthcare settings.MethodsTen online databases were searched to identify studies conducted in primary healthcare settings aimed at implementing interventions to observe the use of EMRs and directly measure the use of EMR functions or outcomes effected by the use of EMR functions.ResultsOf 2098 identified studies, 12 were included in the review. Results showed that interventions focused on the use of EMR functions, including referrals, electronic communication, reminders, use of clinical decision support systems and workflow management support functions, were five times more likely to show improvements in EMR use compared with controls. Interventions focused on data quality were five and a half times more likely to show improvements in EMR use compared with controls.ConclusionsIndividuals in primary healthcare settings aiming to improve EMR use would benefit from implementing interventions focused on EMR feature add-ons such as clinical decision support systems and customised referral templates, and provisions of educational materials, or financial incentives targeted at improving the use of EMR functions and data quality.

Assessing Data Adequacy for High Blood Pressure Clinical Decision Support: A Quantitative Analysis

2021 ◽  
Vol 12 (04) ◽  
pp. 710-720
Author(s):  
David A. Dorr ◽  
Christopher D'Autremont ◽  
Christie Pizzimenti ◽  
Nicole Weiskopf ◽  
Robert Rope ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Decision Support ◽  
Data Quality ◽  
High Blood Pressure ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Unintended Consequences ◽  
Use Cases ◽  
Patient Specific ◽  
Imperfect Data

Abstract Objective This study examines guideline-based high blood pressure (HBP) and hypertension recommendations and evaluates the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources (FHIR)-based, patient-facing clinical decision support (CDS) HBP application. HBP is a major predictor of adverse health events, including stroke, myocardial infarction, and kidney disease. Multiple guidelines recommend interventions to lower blood pressure, but implementation requires patient-centered approaches, including patient-facing CDS tools. Methods We defined concept sets needed to measure adherence to 71 recommendations drawn from eight HBP guidelines. We measured data quality for these concepts for two cohorts (HBP screening and HBP diagnosed) from electronic health record (EHR) data, including four use cases (screening, nonpharmacologic interventions, pharmacologic interventions, and adverse events) for CDS. Results We identified 102,443 people with diagnosed and 58,990 with undiagnosed HBP. We found that 21/35 (60%) of required concept sets were unused or inaccurate, with only 259 (25.3%) of 1,101 codes used. Use cases showed high inclusion (0.9–11.2%), low exclusion (0–0.1%), and missing patient-specific context (up to 65.6%), leading to data in 2/4 use cases being insufficient for accurate alerting. Discussion Data quality from the EHR required to implement recommendations for HBP is highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases. Conclusion Current data quality allows for further development of patient-facing FHIR HBP tools, but extensive validation and testing is required to assure precision and avoid unintended consequences.

scholarly journals Electronic clinical decision support for children with minor head trauma and intracranial injuries: a sociotechnical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacob K. Greenberg ◽  
Ayodamola Otun ◽  
Azzah Nasraddin ◽  
Ross C. Brownson ◽  
Nathan Kuppermann ◽  
...  
Keyword(s):  
Information Technology ◽  
Decision Support ◽  
Focus Group ◽  
Clinical Decision Support ◽  
Thematic Analysis ◽  
Clinical Decision ◽  
Evidence Based ◽  
Minor Head Trauma ◽  
Technology Specialists ◽  
Electronic Clinical Decision Support

Abstract Background Current management of children with minor head trauma (MHT) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) for management of these children may improve patient safety and decrease resource use. To guide these efforts, we evaluated the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure, among other factors. Methods Between March and May, 2020 semi-structured qualitative focus group interviews were conducted to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine health centers in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were then cross-referenced with previously defined sociotechnical dimensions. Results We included 28 physicians and four information technology specialists in seven focus groups (median five participants per group). Five physicians were trainees and 10 had administrative leadership positions. Through inductive thematic analysis, we identified five primary themes: (1) clinical impact; (2) stakeholders and users; (3) tool content; (4) clinical practice integration; and (5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children. However, some had mixed feelings regarding how the tool could best be used by different specialties (e.g. use by neurosurgeons versus non-neurosurgeons). Feedback from the interviews helped refine the tool content and also highlighted potential technical and workflow barriers to address prior to implementation. Conclusions We identified key factors impacting the implementation of electronic CDS for children with MHT and intracranial injuries. These results have informed our implementation strategy and may also serve as a template for future efforts to implement health information technology in a multidisciplinary, emergency setting.

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