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JMIR Med Inform. 2019 Jul 3;7(3):e13627. doi: 10.2196/13627.

Descriptive Usability Study of CirrODS: Clinical Decision and Workflow Support Tool for Management of Patients With Cirrhosis.

Garvin JH1,2,3,4,5,6, Ducom J7, Matheny M8,9,10,11, Miller A12, Westerman D8,10, Reale C12, Slagle J12, Kelly N5, Beebe R12, Koola J8,13, Groessl EJ7,14, Patterson ES1, Weinger M8,12, Perkins AM11, Ho SB7,13,15.

Author information

1
Health Information Management and Systems, The Ohio State University, Columbus, OH, United States.
2
Center for Health Information and Communication, Richard L Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, United States.
3
Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.
4
Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States.
5
Department of Veteran Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States.
6
Division of Epidemiology, University of Utah, Salt Lake City, UT, United States.
7
Department of Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.
8
Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.
9
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
10
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.
11
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States.
12
Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States.
13
Department of Medicine, University of California San Diego, San Diego, CA, United States.
14
Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, United States.
15
Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Abstract

BACKGROUND:

There are gaps in delivering evidence-based care for patients with chronic liver disease and cirrhosis.

OBJECTIVE:

Our objective was to use interactive user-centered design methods to develop the Cirrhosis Order Set and Clinical Decision Support (CirrODS) tool in order to improve clinical decision-making and workflow.

METHODS:

Two work groups were convened with clinicians, user experience designers, human factors and health services researchers, and information technologists to create user interface designs. CirrODS prototypes underwent several rounds of formative design. Physicians (n=20) at three hospitals were provided with clinical scenarios of patients with cirrhosis, and the admission orders made with and without the CirrODS tool were compared. The physicians rated their experience using CirrODS and provided comments, which we coded into categories and themes. We assessed the safety, usability, and quality of CirrODS using qualitative and quantitative methods.

RESULTS:

We created an interactive CirrODS prototype that displays an alert when existing electronic data indicate a patient is at risk for cirrhosis. The tool consists of two primary frames, presenting relevant patient data and allowing recommended evidence-based tests and treatments to be ordered and categorized. Physicians viewed the tool positively and suggested that it would be most useful at the time of admission. When using the tool, the clinicians placed fewer orders than they placed when not using the tool, but more of the orders placed were considered to be high priority when the tool was used than when it was not used. The physicians' ratings of CirrODS indicated above average usability.

CONCLUSIONS:

We developed a novel Web-based combined clinical decision-making and workflow support tool to alert and assist clinicians caring for patients with cirrhosis. Further studies are underway to assess the impact on quality of care for patients with cirrhosis in actual practice.

KEYWORDS:

clinical decision support; human factors engineering; interview; liver cirrhosis

PMID:
31271153
DOI:
10.2196/13627
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