Accepted for/Published in: JMIR Human Factors
Date Submitted: Dec 15, 2018
Open Peer Review Period: Dec 17, 2018 - Dec 3, 2018
Date Accepted: Feb 9, 2019
(closed for review but you can still tweet)
A computerized clinical decision support system for emergency department-initiated buprenorphine for opioid use disorder (EMBED): User-centered design
ABSTRACT
Background:
Emergency Departments (EDs) frequently care for individuals with Opioid Use Disorder (OUD). Buprenorphine (BUP) is an effective treatment option for patients with OUD that can safely be initiated in the ED. At present, BUP is rarely initiated as a part of routine ED care. Clinical decision support (CDS) could accelerate adoption of ED-initiated BUP into routine emergency care.
Objective:
To design and formatively evaluate a user-centered decision support tool for ED initiation of buprenorphine for patients with OUD.
Methods:
User-centered design with iterative prototype development was used. Initial observations and interviews identified workflows and information needs. The design team and key stakeholders reviewed prototype designs to ensure accuracy. Five prototypes were evaluated and iteratively refined informed by feedback from 26 attending and resident physicians until thematic saturation was reached.
Results:
Early feedback identified concerns with the initial CDS design: an alert with several screens. The timing of the alert led to quick dismissal without using the tool. User feedback on subsequent iterations informed the development of a flexible tool to support clinicians with varied levels experience with the intervention by providing both one-click options for direct activation of care pathways as well as user-activated support for critical decision points. The final design resolved challenging navigation issues through targeted placement, color, and design of the decision support modules and care pathways. In final testing, users expressed that the tool could be easily learned without training and was reasonable for use during routine emergency care.
Conclusions:
A user-centered design process helped designers to better understand users’ needs for a web-based clinical decision tool to support ED initiation of buprenorphine for OUD. The process identified varying needs across user experience and familiarity with the protocol, leading to a flexible design supporting both direct care pathways and user-initiated decision support. Clinical Trial: N/A for design,
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.