title: Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise.
abstract: Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration's EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability.
authors.affiliation: Applied Decision Science, Dayton, Ohio.
authors.forename: Laura G
authors.initials: LG
authors.lastname: Militello
authors.affiliation: University of Louisville, Louisville, Kentucky.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Saleem
authors.affiliation: Applied Decision Science, Dayton, Ohio.
authors.forename: Morgan R
authors.initials: MR
authors.lastname: Borders
authors.affiliation: Applied Decision Science, Dayton, Ohio.
authors.forename: Christen E
authors.initials: CE
authors.lastname: Sushereba
authors.affiliation: Centers for Disease Control and Prevention, Albuquerque, New Mexico.
authors.forename: Donald
authors.initials: D
authors.lastname: Haverkamp
authors.affiliation: Applied Decision Science, Cincinnati, Ohio.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Wolf
authors.affiliation: Arizona State University, Phoenix.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
keywords: agile software development; cancer prevention; cognitive task analysis; ethnographic observation; health promotion