An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia
Electronic health record (EHR)-based clinical decision support (CDS) can address the low awareness and undertreatment of familial hypercholesterolemia (FH), a disorder associated with a markedly increased risk of coronary heart disease. We aimed to incorporate provider perspectives into the developm...
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Veröffentlicht in: | Journal of personalized medicine 2020-09, Vol.10 (3), p.67 |
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creator | Bangash, Hana Pencille, Laurie Gundelach, Justin H Makkawy, Ahmed Sutton, Joseph Makkawy, Lenae Dikilitas, Ozan Kopecky, Stephen Freimuth, Robert Caraballo, Pedro J Kullo, Iftikhar J |
description | Electronic health record (EHR)-based clinical decision support (CDS) can address the low awareness and undertreatment of familial hypercholesterolemia (FH), a disorder associated with a markedly increased risk of coronary heart disease. We aimed to incorporate provider perspectives into the development and implementation of a CDS tool for FH. An implementation science framework and a user-centered design process were used to create a CDS tool for FH. Primary care physicians and specialist physicians participated in qualitative interviews, usability testing and an implementation survey. The CDS was configured in two formats—a best practice alert (BPA) and an in-basket message and subsequently deployed in the EHR in silent mode. The key themes that emerged from the analysis of interview transcripts included understanding and awareness of FH, clinical workflow, physician preferences and value of CDS tools, perspectives on patient needs and values and dissemination and implementation. Recommendations related to usability included preferred CDS format and placement, content, timing and frequency, and level of alert urgency/prioritization. In response to the survey, 84.6% of physicians agreed that the CDS would improve early FH diagnosis and 92.3% agreed that it would help them identify and manage FH patients. Physician feedback led to iterative CDS refinement. In summary, we developed a CDS tool for FH using an implementation science framework and physician feedback. Initial deployment revealed a significant burden of FH and the potential for the CDS tool to have a large impact. |
doi_str_mv | 10.3390/jpm10030067 |
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We aimed to incorporate provider perspectives into the development and implementation of a CDS tool for FH. An implementation science framework and a user-centered design process were used to create a CDS tool for FH. Primary care physicians and specialist physicians participated in qualitative interviews, usability testing and an implementation survey. The CDS was configured in two formats—a best practice alert (BPA) and an in-basket message and subsequently deployed in the EHR in silent mode. The key themes that emerged from the analysis of interview transcripts included understanding and awareness of FH, clinical workflow, physician preferences and value of CDS tools, perspectives on patient needs and values and dissemination and implementation. Recommendations related to usability included preferred CDS format and placement, content, timing and frequency, and level of alert urgency/prioritization. In response to the survey, 84.6% of physicians agreed that the CDS would improve early FH diagnosis and 92.3% agreed that it would help them identify and manage FH patients. Physician feedback led to iterative CDS refinement. In summary, we developed a CDS tool for FH using an implementation science framework and physician feedback. Initial deployment revealed a significant burden of FH and the potential for the CDS tool to have a large impact.</description><identifier>ISSN: 2075-4426</identifier><identifier>EISSN: 2075-4426</identifier><identifier>DOI: 10.3390/jpm10030067</identifier><identifier>PMID: 32717811</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>Cardiology ; Cardiovascular disease ; Care and treatment ; Clinical medicine ; Coronary artery disease ; Decision support systems ; Design ; Electronic medical records ; Electronic records ; Etiology ; Feedback ; Heart diseases ; Hypercholesterolemia ; Internal medicine ; Intervention ; Interviews ; Medical records ; Medical research ; Medicine ; Methods ; Patients ; Physicians ; Precision medicine ; Primary care ; Usability testing</subject><ispartof>Journal of personalized medicine, 2020-09, Vol.10 (3), p.67</ispartof><rights>COPYRIGHT 2020 MDPI AG</rights><rights>2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). 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We aimed to incorporate provider perspectives into the development and implementation of a CDS tool for FH. An implementation science framework and a user-centered design process were used to create a CDS tool for FH. Primary care physicians and specialist physicians participated in qualitative interviews, usability testing and an implementation survey. The CDS was configured in two formats—a best practice alert (BPA) and an in-basket message and subsequently deployed in the EHR in silent mode. The key themes that emerged from the analysis of interview transcripts included understanding and awareness of FH, clinical workflow, physician preferences and value of CDS tools, perspectives on patient needs and values and dissemination and implementation. Recommendations related to usability included preferred CDS format and placement, content, timing and frequency, and level of alert urgency/prioritization. In response to the survey, 84.6% of physicians agreed that the CDS would improve early FH diagnosis and 92.3% agreed that it would help them identify and manage FH patients. Physician feedback led to iterative CDS refinement. In summary, we developed a CDS tool for FH using an implementation science framework and physician feedback. 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We aimed to incorporate provider perspectives into the development and implementation of a CDS tool for FH. An implementation science framework and a user-centered design process were used to create a CDS tool for FH. Primary care physicians and specialist physicians participated in qualitative interviews, usability testing and an implementation survey. The CDS was configured in two formats—a best practice alert (BPA) and an in-basket message and subsequently deployed in the EHR in silent mode. The key themes that emerged from the analysis of interview transcripts included understanding and awareness of FH, clinical workflow, physician preferences and value of CDS tools, perspectives on patient needs and values and dissemination and implementation. Recommendations related to usability included preferred CDS format and placement, content, timing and frequency, and level of alert urgency/prioritization. In response to the survey, 84.6% of physicians agreed that the CDS would improve early FH diagnosis and 92.3% agreed that it would help them identify and manage FH patients. Physician feedback led to iterative CDS refinement. In summary, we developed a CDS tool for FH using an implementation science framework and physician feedback. Initial deployment revealed a significant burden of FH and the potential for the CDS tool to have a large impact.</abstract><cop>Basel</cop><pub>MDPI AG</pub><pmid>32717811</pmid><doi>10.3390/jpm10030067</doi><orcidid>https://orcid.org/0000-0002-2631-9314</orcidid><orcidid>https://orcid.org/0000-0001-7347-0511</orcidid><orcidid>https://orcid.org/0000-0001-9050-7080</orcidid><orcidid>https://orcid.org/0000-0003-2552-9499</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Cardiology Cardiovascular disease Care and treatment Clinical medicine Coronary artery disease Decision support systems Design Electronic medical records Electronic records Etiology Feedback Heart diseases Hypercholesterolemia Internal medicine Intervention Interviews Medical records Medical research Medicine Methods Patients Physicians Precision medicine Primary care Usability testing |
title | An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia |
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