Integrated displays to improve chronic disease management in ambulatory care: A SMART on FHIR application informed by mixed-methods user testing

被引：21

作者：

Curran, Rebecca L. ^{[1
]}

Kukhareva, Polina, V ^{[1
]}

Taft, Teresa ^{[1
]}

Weir, Charlene R. ^{[1
]}

Reese, Thomas J. ^{[1
]}

Nanjo, Claude ^{[1
]}

Rodriguez-Loya, Salvador ^{[1
]}

Martin, Douglas K. ^{[1
]}

Warner, Phillip B. ^{[1
]}

Shields, David E. ^{[1
]}

Flynn, Michael C. ^{[2
]}

Boltax, Jonathan P. ^{[3
]}

Kawamoto, Kensaku ^{[1
]}

机构：

[1] Univ Utah, Dept Biomed Informat, 421 Wakara Way,Suite 140, Salt Lake City, UT 84108 USA

[2] Univ Utah, Community Phys Grp, Salt Lake City, UT 84108 USA

[3] Univ Utah, Div Pulm & Crit Care, Dept Internal Med, Salt Lake City, UT 84108 USA

来源：

JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION | 2020年 / 27卷 / 08期

基金：

美国国家卫生研究院; 美国医疗保健研究与质量局;

关键词：

electronic health records; decision support systems; clinical; SMART on FHIR; human-computer interaction; cognitive load; ELECTRONIC HEALTH RECORD; GUIDELINES; ADHERENCE; BARRIERS; SYSTEM; TIME;

D O I：

10.1093/jamia/ocaa099

中图分类号：

TP [自动化技术、计算机技术];

学科分类号：

0812 ;

摘要：

Objective: The study sought to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. Materials and Methods: We designed a chronic disease management application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). We used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Each participant managed 2 patient scenarios using the regular EHR with and without access to our prototype in block-randomized order. The primary outcome was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. User experiences were captured using a retrospective think-aloud interview analyzed by concept coding. Results: With our prototype, the 13 participants completed more recommended care (81% vs 48%; P< .0 01) and recommended tasks per minute (0.8 vs 0.6; P= .03) over longer sessions (7.0 minutes vs 5.4 minutes; P= .0 06). Keystrokes per task were lower with the prototype (6 vs 18; P< .001). Qualitative themes elicited included the desire for reliable presentation of information which matches participants' mental models of disease and for intuitive navigation in order to decrease cognitive load. Discussion: Participants completed more recommended care by taking more time when using our prototype. Interviews identified a tension between using the inefficient but familiar EHR vs learning to use our novel prototype. Concept coding of user feedback generated actionable insights. Conclusions: Mixed methods can support the design and evaluation of SMART on FHIR EHR add-on applications by enhancing understanding of the user experience.

引用

页码：1225 / 1234

页数：10

共 41 条

[1] Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians [J].

Adler-Milstein, Julia ;

Zhao, Wendi ;

Willard-Grace, Rachel ;

Knox, Margae ;

Grumbach, Kevin .

JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 2020, 27 (04) :531-538

[2]

Aydin CE, 1997, J AM MED INFORM ASSN, P677

[3] Opening the Duke electronic health record to apps: Implementing SMART on FHIR [J].

Bloomfield, Richard A., Jr. ;

Polo-Wood, Felipe ;

Mandel, Joshua C. ;

Mandl, Kenneth D. .

INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS, 2017, 99 :1-10

[4] Time and feasibility of prevention in primary care [J].

Bucher, Sophie ;

Maury, Arnaud ;

Rosso, Julie ;

de Chanaud, Nicolas ;

Bloy, Geraldine ;

Pendola-Luchel, Isabelle ;

Delpech, Raphaelle ;

Paquet, Sylvain ;

Falcoff, Hector ;

Ringa, Virginie ;

Rigal, Laurent .

FAMILY PRACTICE, 2017, 34 (01) :49-56

[5] Primary Care Visit Duration and Quality Does Good Care Take Longer? [J].

Chen, Lena M. ;

Farwell, Wildon R. ;

Jha, Ashish K. .

ARCHIVES OF INTERNAL MEDICINE, 2009, 169 (20) :1866-1872

[6] Determining Primary Care Physician Information Needs to Inform Ambulatory Visit Note Display [J].

Clarke, M. A. ;

Steege, L. M. ;

Moore, J. L. ;

Koopman, R. J. ;

Belden, J. L. ;

Kim, M. S. .

APPLIED CLINICAL INFORMATICS, 2014, 5 (01) :169-190

[7]

Dore L, 1995, Proc Annu Symp Comput Appl Med Care, P377

[8] User perception and experience of the introduction of a novel critical care patient viewer in the ICU setting [J].

Dziadzko, Mikhail A. ;

Herasevich, Vitaly ;

Sen, Ayan ;

Pickering, Brian W. ;

Knight, Ann-Marie A. ;

Franco, Pablo Moreno .

INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS, 2016, 88 :86-91

[9]

Forsythe D E, 1991, Proc Annu Symp Comput Appl Med Care, P8

[10] Using the framework method for the analysis of qualitative data in multi-disciplinary health research [J].

Gale, Nicola K. ;

Heath, Gemma ;

Cameron, Elaine ;

Rashid, Sabina ;

Redwood, Sabi .

BMC MEDICAL RESEARCH METHODOLOGY, 2013, 13

← 1 2 3 4 5 →