Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, California, USA.
School of Medicine Technology Services, University of California-San Francisco, San Francisco, California, USA.
Hepatol Commun. 2024 Feb 26;8(3). doi: 10.1097/HC9.0000000000000394. eCollection 2024 Mar 1.
Electronic health record (EHR)-based clinical decision support is a scalable way to help standardize clinical care. Clinical decision support systems have not been extensively investigated in cirrhosis management. Human-centered design (HCD) is an approach that engages with potential users in intervention development. In this study, we applied HCD to design the features and interface for a clinical decision support system for cirrhosis management, called CirrhosisRx.
We conducted technical feasibility assessments to construct a visual blueprint that outlines the basic features of the interface. We then convened collaborative-design workshops with generalist and specialist clinicians. We elicited current workflows for cirrhosis management, assessed gaps in existing EHR systems, evaluated potential features, and refined the design prototype for CirrhosisRx. At the conclusion of each workshop, we analyzed recordings and transcripts.
Workshop feedback showed that the aggregation of relevant clinical data into 6 cirrhosis decompensation domains (defined as common inpatient clinical scenarios) was the most important feature. Automatic inference of clinical events from EHR data, such as gastrointestinal bleeding from hemoglobin changes, was not accepted due to accuracy concerns. Visualizations for risk stratification scores were deemed not necessary. Lastly, the HCD co-design workshops allowed us to identify the target user population (generalists).
This is one of the first applications of HCD to design the features and interface for an electronic intervention for cirrhosis management. The HCD process altered features, modified the design interface, and likely improved CirrhosisRx's overall usability. The finalized design for CirrhosisRx proceeded to development and production and will be tested for effectiveness in a pragmatic randomized controlled trial. This work provides a model for the creation of other EHR-based interventions in hepatology care.
基于电子健康记录 (EHR) 的临床决策支持是帮助规范临床护理的一种可扩展方法。临床决策支持系统尚未在肝硬化管理中得到广泛研究。以人为中心的设计 (HCD) 是一种与潜在用户合作进行干预措施开发的方法。在这项研究中，我们应用 HCD 来设计肝硬化管理临床决策支持系统的功能和界面，称为 CirrhosisRx。
我们进行了技术可行性评估，以构建概述界面基本功能的视觉蓝图。然后，我们召集了一般和专科临床医生共同设计研讨会。我们征集了肝硬化管理的当前工作流程，评估了现有 EHR 系统中的差距，评估了潜在功能，并为 CirrhosisRx 完善了设计原型。在每次研讨会结束时，我们分析了录音和记录。
研讨会的反馈表明，将相关临床数据聚合到 6 个肝硬化失代偿域（定义为常见住院临床场景）是最重要的功能。由于准确性问题，从 EHR 数据自动推断临床事件（例如血红蛋白变化引起的胃肠道出血）不被接受。用于风险分层评分的可视化被认为是不必要的。最后，HCD 共同设计研讨会使我们能够确定目标用户群体（全科医生）。
这是首次应用 HCD 来设计肝硬化管理电子干预措施的功能和界面。HCD 流程改变了功能，修改了设计界面，并可能提高了 CirrhosisRx 的整体可用性。CirrhosisRx 的最终设计进入开发和生产阶段，并将在一项实用的随机对照试验中测试其有效性。这项工作为创建其他肝科学护理中基于 EHR 的干预措施提供了一个模型。
