Anne Miller1, Jejo D Koola2, Michael E Matheny3, Julie H Ducom4, Jason M Slagle1, Erik J Groessl5, Freneka F Minter3, Jennifer H Garvin6, Matthew B Weinger1, Samuel B Ho7. 1. Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, USA; Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA. 2. Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, USA; Departments of Medicine and Biomedical Informatics, University of California, San Diego, CA, USA. 3. Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, USA; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA. 4. Health Service Research and Development, VA San Diego Healthcare System, San Diego, CA, USA. 5. Health Service Research and Development, VA San Diego Healthcare System, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, CA, USA. 6. VA Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; Division of Health Information Management and Systems, Ohio State University, Columbus, OH, USA. 7. Health Service Research and Development, VA San Diego Healthcare System, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA. Electronic address: ho.samuel@sbcglobal.net.
Abstract
BACKGROUND & OBJECTIVES: In healthcare, the routine use of evidence-based specialty care management plans is mixed. Targeted computerized clinical decision support (CCDS) interventions can improve physician adherence, but adoption depends on CCDS' 'fit' within clinical work. We analyzed clinical work in outpatient and inpatient settings as a basis for developing guidelines for optimizing CCDS design. METHODS: The contextual design approach guided data collection, collation and analysis. Forty (40) consenting physicians were observed and interviewed in general internal medicine inpatient units and gastroenterology (GI) outpatient clinics at two academic medical centers. Data were collated using interpretive debriefing, and consolidated using thematic analysis and three work modeling approaches (communication flow, sequence and artifact models). RESULTS: Twenty-six consenting physicians were observed at Site A and 14 at Site B. Observations included attending (33%) and resident physicians. During research team debriefings, 220 of 341 unique topics were categorized into 5 CCDS-relevant themes. Resident physicians relied on patient assessment & planning processes to support their roles as communication and coordination hubs within the medical team. Artifact analysis further elucidated the evolution of assessment and planning over work shifts. CONCLUSIONS: The usefulness of CCDS tools may be enhanced in clinical care if the design: 1) accounts for clinical work that is distributed across people, space, and time; 2) targets communication and coordination hubs (specific roles) that can amplify the usefulness of CCDS interventions; 3) integrates CCDS with early clinical assessment & planning processes; and 4) provides CCDS in both electronic & hardcopy formats. These requirements provide a research agenda for future research in clinician-CCDS integration. Published by Elsevier B.V.
BACKGROUND & OBJECTIVES: In healthcare, the routine use of evidence-based specialty care management plans is mixed. Targeted computerized clinical decision support (CCDS) interventions can improve physician adherence, but adoption depends on CCDS' 'fit' within clinical work. We analyzed clinical work in outpatient and inpatient settings as a basis for developing guidelines for optimizing CCDS design. METHODS: The contextual design approach guided data collection, collation and analysis. Forty (40) consenting physicians were observed and interviewed in general internal medicine inpatient units and gastroenterology (GI) outpatient clinics at two academic medical centers. Data were collated using interpretive debriefing, and consolidated using thematic analysis and three work modeling approaches (communication flow, sequence and artifact models). RESULTS: Twenty-six consenting physicians were observed at Site A and 14 at Site B. Observations included attending (33%) and resident physicians. During research team debriefings, 220 of 341 unique topics were categorized into 5 CCDS-relevant themes. Resident physicians relied on patient assessment & planning processes to support their roles as communication and coordination hubs within the medical team. Artifact analysis further elucidated the evolution of assessment and planning over work shifts. CONCLUSIONS: The usefulness of CCDS tools may be enhanced in clinical care if the design: 1) accounts for clinical work that is distributed across people, space, and time; 2) targets communication and coordination hubs (specific roles) that can amplify the usefulness of CCDS interventions; 3) integrates CCDS with early clinical assessment & planning processes; and 4) provides CCDS in both electronic & hardcopy formats. These requirements provide a research agenda for future research in clinician-CCDS integration. Published by Elsevier B.V.
Entities:
Keywords:
Cirrhosis; Computerized clinical decision support; Contextual design methods; Human factors engineering; Specialty care
Authors: Mustafa Ozkaynak; Noel Metcalf; Daniel M Cohen; Larissa S May; Peter S Dayan; Rakesh D Mistry Journal: Appl Clin Inform Date: 2020-09-09 Impact factor: 2.342
Authors: Wills C Dunham; Matthew B Weinger; Jason Slagle; Mias Pretorius; Ashish S Shah; Tarek S Absi; Matthew S Shotwell; Marc Beller; Erica Thomas; Cindy L Vnencak-Jones; Robert E Freundlich; Jonathan P Wanderer; Warren S Sandberg; Miklos D Kertai Journal: J Cardiothorac Vasc Anesth Date: 2019-09-10 Impact factor: 2.628
Authors: Jennifer Hornung Garvin; Julie Ducom; Michael Matheny; Anne Miller; Dax Westerman; Carrie Reale; Jason Slagle; Natalie Kelly; Russ Beebe; Jejo Koola; Erik J Groessl; Emily S Patterson; Matthew Weinger; Amy M Perkins; Samuel B Ho Journal: JMIR Med Inform Date: 2019-07-03