计算机化医嘱录入系统中药基因组学临床决策支持辅助工具和临床知识资源的可用性评估：一种混合方法

Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach.

作者信息

Devine Emily Beth, Lee Chia-Ju, Overby Casey L, Abernethy Neil, McCune Jeannine, Smith Joe W, Tarczy-Hornoch Peter

机构信息

Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States; Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States.

Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States.

出版信息

Int J Med Inform. 2014 Jul;83(7):473-83. doi: 10.1016/j.ijmedinf.2014.04.008. Epub 2014 May 9.

DOI:10.1016/j.ijmedinf.2014.04.008

PMID:24874987

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4095746/

Abstract

BACKGROUND

Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption.

OBJECTIVES

The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers.

METHODS

Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making.

RESULTS

Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree).

CONCLUSIONS

Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and useful ways.

摘要

背景

药物基因组学（PGx）有望对医学实践产生广泛影响，但医生的接受度较低。以嵌入计算机化医嘱录入（CPOE）系统的临床决策支持（CDS）警报形式呈现特定背景的PGx信息，有助于提高其接受度。可用性评估可为优化设计提供参考，进而促进其应用。

目的

本研究旨在：（1）在模拟环境中评估具有PGx-CDS警报的早期原型商业CPOE系统；（2）确定系统用户界面的潜在改进之处；（3）了解电子健康记录中嵌入的PGx知识对开处方者有用的背景情况。

方法

我们采用混合方法，向7名心脏病专家和3名肿瘤学家展示了5个假设的临床病例场景。每个场景都涉及一种药物，对于该药物，编码药物代谢酶的基因需要考虑剂量调整。当参与者为每种药物开处方时，我们使用Morae（®）来记录评论和屏幕操作。除了PGx-CDS警报外，“信息按钮（®）”和“证据”图标为参与者提供临床知识资源，以辅助决策。

结果

出现了9个主题。其中5个主题建议对CPOE用户界面进行小的改进；2个主题建议通过使用“信息按钮”或“证据”图标，通过PGx-CDS警报呈现PGx信息。其余主题强烈建议提供来自可靠和可信赖来源的简洁、相关指南以及表型信息的给药建议；过多信息会让人应接不暇。在从1（强烈同意）到7（强烈不同意）的李克特量表上，参与者对PGx-CDS系统可用性的中位数评分为2。