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. 2022 Mar 16;9(1):e29019.
doi: 10.2196/29019.

Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System-Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses

Emma K Jones  1 , Alyssa Banks  2 , Genevieve B Melton  1 , Carolyn M Porta  3 , Christopher J Tignanelli  1   4
Affiliations

Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System-Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses

Emma K Jones et al. JMIR Hum Factors. .

Abstract

Background: Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance.

Objective: This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology.

Methods: A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map.

Results: A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently.

Conclusions: End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption.

Keywords: Unified Theory of Acceptance and Use of Technology; clinical decision support systems; human computer interaction; rib fractures; trauma.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Prototype rib fracture clinical decision support (CDS) care map summary. BPA: best practice advisory; CAPA: clinically aligned pain assessment; CXR: chest x-ray; ED: emergency department; EWS: early warning system; PIC: pain inspiration cough; RN: registered nurse.
Figure 2
Figure 2
Eight themes for the development of acceptable clinical decision support systems (CDSS). CDS: clinical decision support; EB: evidence based; EHR: electronic health record.
Figure 3
Figure 3
Final rib fracture clinical decision support (CDS) care map workflow (new elements designated by purple arrows). BPA: best practice advisory; CAPA: clinically aligned pain assessment; CDS: clinical decision support; CT: computed tomography; CTA: computed tomography angiography; CXR: chest x-ray; ED: emergency department; EWS: early warning system; PIC: pain inspiration cough; ICU: intensive care unit; IV: intravenous; RN: registered nurse; S/F: oxygen saturation/fraction of inspired oxygen ratio.
Figure 4
Figure 4
Process and sequence for the development of acceptable clinical decision support system (CDSS) care maps [2,3,13,38-41]. EHR: electronic health record; IT: information technology.
See this image and copyright information in PMC

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