Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle (Hartzler); Kaiser Permanente Washington Health Research Institute, Seattle (Ralston, Hannan, Penfold); Nationwide Children's Hospital, Abigail Wexner Research Institute, Center for Innovation in Pediatric Practice, Columbus, Ohio (Kelleher).
Psychiatr Serv. 2019 Oct 1;70(10):944-947. doi: 10.1176/appi.ps.201800390. Epub 2019 Jul 16.
Guidelines recommend against prescribing antipsychotics without an indication, yet prescription rates remain undesirably high for youths. Information technology can facilitate guideline-based prescribing, but little is known about providers' needs. The Safer Use of Antipsychotics in Youth project is implementing an algorithm-based workflow for peer consultation, care navigation, and expedited psychotherapy access. To optimize workflow for a multisite trial, we engaged providers for input.
Guided by human-centered design, we interviewed 15 providers from Kaiser Permanente Washington and Nationwide Children's Hospital about their prescribing barriers and workflow preferences. We identified qualitative themes on barriers affecting implementation and design opportunities to optimize workflow.
Providers expressed two major barriers: potential disruptions to clinical practice and threats to professional autonomy. Three design opportunities emerged: à la carte orders, passive review of orders, and consultation self-acknowledgment.
Human-centered design offers an innovative approach to improve guideline-based prescribing with optimizations that are grounded in providers' needs.
指南建议不要在没有指征的情况下开具抗精神病药物，但青少年的处方率仍然高得令人不适。信息技术可以促进基于指南的处方，但人们对提供者的需求知之甚少。“青少年更安全地使用抗精神病药物”项目正在实施一种基于算法的同行咨询、护理导航和加速心理治疗途径的工作流程。为了优化多站点试验的工作流程，我们邀请提供者提供意见。
我们采用以人为中心的设计，采访了来自 Kaiser Permanente Washington 和 Nationwide Children's Hospital 的 15 名提供者，了解他们在处方方面的障碍和对工作流程偏好。我们确定了影响实施的定性主题和优化工作流程的设计机会。
提供者表达了两个主要障碍：对临床实践的潜在干扰和对专业自主权的威胁。出现了三个设计机会：点菜式订单、订单被动审查和咨询自我认可。
以人为中心的设计为改善基于指南的处方提供了一种创新方法，其优化是基于提供者的需求。
