Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 23;9(1):e30130.
doi: 10.2196/30130.

A Patient Outcomes-Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP)

Alexandra T Strauss  1 , Cameron Morgan  2 , Christopher El Khuri  3 , Becky Slogeris  2 , Aria G Smith  3 , Eili Klein  3 , Matt Toerper  3   4 , Anthony DeAngelo  4 , Arnaud Debraine  4 , Susan Peterson  3 , Ayse P Gurses  3   5   6 , Scott Levin  3   4 , Jeremiah Hinson  3   4
Affiliations

A Patient Outcomes-Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP)

Alexandra T Strauss et al. JMIR Hum Factors. .

Abstract

Background: The availability of patient outcomes-based feedback is limited in episodic care environments such as the emergency department. Emergency medicine (EM) clinicians set care trajectories for a majority of hospitalized patients and provide definitive care to an even larger number of those discharged into the community. EM clinicians are often unaware of the short- and long-term health outcomes of patients and how their actions may have contributed. Despite large volumes of patients and data, outcomes-driven learning that targets individual clinician experiences is meager. Integrated electronic health record (EHR) systems provide opportunity, but they do not have readily available functionality intended for outcomes-based learning.

Objective: This study sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes feedback platform for EM clinicians. Here, we describe the iterative development of this platform, Linking Outcomes Of Patients (LOOP), under a human-centered design framework, including structured feedback obtained from its use.

Methods: This multimodal study consisting of human-centered design studios, surveys (24 physicians), interviews (11 physicians), and a LOOP application usability evaluation (12 EM physicians for ≥30 minutes each) was performed between August 2019 and February 2021. The study spanned 3 phases: (1) conceptual development under a human-centered design framework, (2) LOOP technical platform development, and (3) usability evaluation comparing pre- and post-LOOP feedback gathering practices in the EHR.

Results: An initial human-centered design studio and EM clinician surveys revealed common themes of disconnect between EM clinicians and their patients after the encounter. Fundamental postencounter outcomes of death (15/24, 63% respondents identified as useful), escalation of care (20/24, 83%), and return to ED (16/24, 67%) were determined high yield for demonstrating proof-of-concept in our LOOP application. The studio aided the design and development of LOOP, which integrated physicians throughout the design and content iteration. A final LOOP prototype enabled usability evaluation and iterative refinement prior to launch. Usability evaluation compared to status quo (ie, pre-LOOP) feedback gathering practices demonstrated a shift across all outcomes from "not easy" to "very easy" to obtain and from "not confident" to "very confident" in estimating outcomes after using LOOP. On a scale from 0 (unlikely) to 10 (most likely), the users were very likely (9.5) to recommend LOOP to a colleague.

Conclusions: This study demonstrates the potential for human-centered design of a patient outcomes-driven feedback platform for individual EM providers. We have outlined a framework for working alongside clinicians with a multidisciplined team to develop and test a tool that augments their clinical experience and enables closed-loop learning.

Keywords: ER; closed-loop learning; emergency medicine; emergency room; feedback; health informatics; human-centered design; outcomes; platform; practice-based learning and improvement; usability.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: JH serves as StoCastic’s Chief Medical Officer and SL serves as StoCastic’s Chief Technical Officer; both own equity in StoCastic. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. AdA and AD, members of the digital health company StoCastic, also contributed to this project. The other authors do not have any other conflicts of interest.

Figures

Figure 1
Figure 1
Human-centered design methods used to develop Linking Outcomes Of Patients. CDEM: Center for Data Science in Emergency Medicine.
Figure 2
Figure 2
Six user personas generated during human-centered design studios and used to drive tool development and to perform internal prototype testing.
Figure 3
Figure 3
Evolution of Linking Outcomes Of Patients from human-centered design studios going from (A) physician prototypes to the (B) final version used in the usability evaluation. EHR: electronic health record; LOOP: Linking Outcomes Of Patients.
Figure 4
Figure 4
Participant attitudes about usefulness of access to outcomes at individual patient level and across all their patients.
Figure 5
Figure 5
Participant attitudes about Linking Outcomes Of Patients. LOOP: Linking Outcomes Of Patients.
See this image and copyright information in PMC

References

    1. Staker LV. Practice-based learning for improvement: the pursuit of clinical excellence. Tex Med. 2000 Oct;96(10):53–60. - PubMed
    1. Hayden SR, Dufel S, Shih R. Definitions and competencies for practice-based learning and improvement. Acad Emerg Med. 2002 Nov;9(11):1242–8. doi: 10.1111/j.1553-2712.2002.tb01584.x. https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pu... - DOI - PubMed
    1. Burke AE, Benson B, Englander R, Carraccio C, Hicks PJ. Domain of competence: Practice-based learning and improvement. Acad Pediatr. 2014;14(2 Suppl):S38–54. doi: 10.1016/j.acap.2013.11.018.S1876-2859(13)00333-1 - DOI - PubMed
    1. Epstein RM. Mindful practice. JAMA. 1999 Sep 01;282(9):833–9. doi: 10.1001/jama.282.9.833.jsc90157 - DOI - PubMed
    1. Berwick DM. Developing and testing changes in delivery of care. Ann Intern Med. 1998 Apr 15;128(8):651–6. doi: 10.7326/0003-4819-128-8-199804150-00009. - DOI - PubMed