title: Evaluation of the acceptability and usability of a decision support system to encourage safe and effective use of opioid therapy for chronic, noncancer pain by primary care providers.
abstract: OBJECTIVE
  To develop and evaluate a clinical decision support system (CDSS) named Assessment and Treatment in Healthcare: Evidenced-Based Automation (ATHENA)-Opioid Therapy, which encourages safe and effective use of opioid therapy for chronic, noncancer pain.
  
  
  METHODS
  CDSS development and iterative evaluation using the analysis, design, development, implementation, and evaluation process including simulation-based and in-clinic assessments of usability for providers followed by targeted system revisions.
  
  
  RESULTS
  Volunteers provided detailed feedback to guide improvements in the graphical user interface, and content and design changes to increase clinical usefulness, understandability, clinical workflow fit, and ease of completing guideline recommended practices. Revisions based on feedback increased CDSS usability ratings over time. Practice concerns outside the scope of the CDSS were also identified.
  
  
  CONCLUSIONS
  Usability testing optimized the CDSS to better address barriers such as lack of provider education, confusion in dosing calculations and titration schedules, access to relevant patient information, provider discontinuity, documentation, and access to validated assessment tools. It also highlighted barriers to good clinical practice that are difficult to address with CDSS technology in its current conceptualization. For example, clinicians indicated that constraints on time and competing priorities in primary care, discomfort in patient-provider communications, and lack of evidence to guide opioid prescribing decisions impeded their ability to provide effective, guideline-adherent pain management. Iterative testing was essential for designing a highly usable and acceptable CDSS; however, identified barriers may limit the impact of the ATHENA-Opioid Therapy system and other CDSS on clinical practices and outcomes unless CDSS are paired with parallel initiatives to address these issues.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA. Jodie.Trafton@va.gov
authors.forename: Jodie
authors.initials: J
authors.lastname: Trafton
authors.forename: Susana
authors.initials: S
authors.lastname: Martins
authors.forename: Martha
authors.initials: M
authors.lastname: Michel
authors.forename: Eleanor
authors.initials: E
authors.lastname: Lewis
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.forename: Ann
authors.initials: A
authors.lastname: Combs
authors.forename: Naquell
authors.initials: N
authors.lastname: Scates
authors.forename: Samson
authors.initials: S
authors.lastname: Tu
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D014584:User-Computer Interface
chemical_list: D000701:Analgesics, Opioid