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. 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

Jennifer Hornung Garvin  1   2   3   4   5   6 , Julie Ducom  7 , Michael Matheny  8   9   10   11 , Anne Miller  12 , Dax Westerman  8   10 , Carrie Reale  12 , Jason Slagle  12 , Natalie Kelly  5 , Russ Beebe  12 , Jejo Koola  8   13 , Erik J Groessl  7   14 , Emily S Patterson  1 , Matthew Weinger  8   12 , Amy M Perkins  11 , Samuel B Ho  7   13   15
Affiliations

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

Jennifer Hornung Garvin et al. JMIR Med Inform. .

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.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Design process. CirrODS: Cirrhosis Order Set and Clinical Decision Support.
Figure 2
Figure 2
Initial clinical decision and workflow support tool prototype used in simulations. GI: gastrointestinal.
Figure 3
Figure 3
Example of concept design envisioned at the end of the design workshop.
Figure 4
Figure 4
Examples from participant interviews of six positions representing perceived barriers and facilitators reported by Liberati et al [50]. CDSS: clinical decision support system.
See this image and copyright information in PMC

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