title: Formative assessment and design of a complex clinical decision support tool for pulmonary embolism.
abstract: 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.
authors.affiliation: Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA.
authors.forename: Sundas
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: McCullagh
authors.affiliation: Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Press
authors.affiliation: Department of Medical Informatics and Care Delivery Innovation, Cooper University Health Care, Camden, New Jersey, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Kharche
authors.affiliation: Department of Information Technology, North Shore-LIJ Health System, Manhasset, New York, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Schachter
authors.affiliation: Department of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pardo
authors.affiliation: Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: McGinn
mesh_terms: D020000:Decision Support Systems, Clinical; D004636:Emergency Service, Hospital; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy
keywords: EDUCATION & TRAINING (see Medical Education & Training)