Mass General Brigham, 399 Revolution Drive, Somerville, MA, 857-282-4091, USA.
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
BMC Med Inform Decis Mak. 2022 Aug 13;22(1):217. doi: 10.1186/s12911-022-01962-y.
Primary care providers face challenges in recognizing and controlling hypertension in patients with chronic kidney disease (CKD). Clinical decision support (CDS) has the potential to aid clinicians in identifying patients who could benefit from medication changes. This study designed an alert to control hypertension in CKD patients using an iterative human-centered design process.
In this study, we present a human-centered design process employing multiple methods for gathering user requirements and feedback on design and usability. Initially, we conducted contextual inquiry sessions to gather user requirements for the CDS. This was followed by group design sessions and one-on-one formative think-aloud sessions to validate requirements, obtain feedback on the design and layout, uncover usability issues, and validate changes.
This study included 20 participants. The contextual inquiry produced 10 user requirements which influenced the initial alert design. The group design sessions revealed issues related to several themes, including recommendations and clinical content that did not match providers' expectations and extraneous information on the alerts that did not provide value. Findings from the individual think-aloud sessions revealed that participants disagreed with some recommended clinical actions, requested additional information, and had concerns about the placement in their workflow. Following each step, iterative changes were made to the alert content and design.
This study showed that participation from users throughout the design process can lead to a better understanding of user requirements and optimal design, even within the constraints of an EHR alerting system. While raising awareness of design needs, it also revealed concerns related to workflow, understandability, and relevance.
The human-centered design framework using multiple methods for CDS development informed the creation of an alert to assist in the treatment and recognition of hypertension in patients with CKD.
初级保健提供者在识别和控制慢性肾脏病（CKD）患者的高血压方面面临挑战。临床决策支持（CDS）有可能帮助临床医生识别可能从药物治疗改变中获益的患者。本研究设计了一个使用迭代以人为中心的设计过程来控制 CKD 患者高血压的警报。
在这项研究中，我们介绍了一个以人为中心的设计过程，该过程采用多种方法收集用户对设计和可用性的需求和反馈。最初，我们进行了情境查询会议，以收集 CDS 的用户需求。随后进行了小组设计会议和一对一的形成性思考大声会议，以验证需求，获得对设计和布局的反馈，发现可用性问题，并验证更改。
本研究包括 20 名参与者。情境查询产生了 10 项用户需求，这些需求影响了初始警报设计。小组设计会议揭示了与几个主题相关的问题，包括与提供者期望不匹配的建议和临床内容以及警报上没有提供价值的多余信息。个别思考大声会议的结果表明，参与者不同意一些推荐的临床操作，要求提供更多信息，并对工作流程中的位置表示担忧。在每个步骤之后，对警报内容和设计进行了迭代更改。
本研究表明，在设计过程中让用户全程参与可以更好地了解用户需求和优化设计，即使在 EHR 警报系统的限制内也是如此。虽然提高了对设计需求的认识，但也揭示了与工作流程、可理解性和相关性相关的问题。
使用多种方法进行 CDS 开发的以人为中心的设计框架为创建一个警报提供了信息，以帮助治疗和识别 CKD 患者的高血压。
