Militello Laura G, Saleem Jason J, Borders Morgan R, Sushereba Christen E, Haverkamp Donald, Wolf Steven P, Doebbeling Bradley N
Applied Decision Science, Dayton, Ohio.
University of Louisville, Louisville, Kentucky.
J Cogn Eng Decis Mak. 2016 Mar;10(1):74-90. doi: 10.1177/1555343416630875.
Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration's EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability.
临床决策支持的应用一直有限。重要障碍包括强调决策支持的算法方法，这些方法与临床工作流程和人类决策策略不太匹配，以及在现有电子健康记录（EHR）中开发、实施和完善决策支持功能的成本和挑战。我们应用以决策为中心的设计来创建一个模块化软件应用程序，以支持医生管理和跟踪结直肠癌筛查。使用以决策为中心的设计有助于从最终用户的角度全面了解认知支持需求，作为设计的基础。在这个项目中，我们使用了迭代设计过程，包括人种学观察和认知任务分析，从最初的设计概念发展到一个名为筛查与监测应用程序的实用模块化软件应用程序。测试版是为与退伍军人健康管理局的电子健康记录计算机化患者记录系统（CPRS）配合使用而定制的。与仅使用CPRS的初级保健提供者相比，使用测试版筛查与监测应用程序的初级保健提供者能更准确地回答有关患者的问题，并更快地找到相关信息。初级保健提供者还报告说，使用该应用程序后脑力劳动减少，并对筛查与监测应用程序的可用性给予了积极评价。
