Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 17, 2023
Date Accepted: Feb 17, 2024
User-centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged with Tailored Implementation Strategies
ABSTRACT
Background:
Electronic health record-based clinical decision support (CDS) tools can support facilitate adoption of evidence into practice. Yet, impact of CDS beyond single site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogenous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts.
Objective:
To develop a framework to guide tailoring and implementing clinical decision support across diverse clinical settings.
Methods:
In preparation for a multi-site trial implementing CDS for pediatric overweight/obesity in primary care, we developed the User-centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user centered design (UCD), human factors/ergonomics (HFE) theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team engaged pediatric primary care clinicians and a diverse group of stakeholders from three health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation.
Results:
The UFIT framework includes steps of UCD by identifying users’ needs; incorporates HFE’s concept of situation awareness; defines and considers HFE’s Systems Engineering Initiative for Patient Safety model’s system-level factors influencing adoption; and applies the Consolidated Framework for Implementation Research to identify potential barriers and facilitators to implementation. We describe the steps of the resulting UFIT and how we applied it to develop iPOP-UP (Improving Pediatric Obesity Practice Using Prompts), a package that bundles CDS with tailored implementation strategies.
Conclusions:
UFIT integrates theories and guidance from UCD, HFE, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide development of iPOP-UP, an integrated package comprising CDS for obesity/overweight treatment with tailored implementation strategies. The package, designed to accommodate diverse needs across three health systems will be tested in a randomized control trial. Clinical Trial: ClinicalTrials.gov Identifier: NCT05627011
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