An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia

Abstract

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.

Developing an Ophthalmology Clinical Decision Support System to Identify Patients for Low Vision Rehabilitation

“…[2][3][4][5][6] A best practice advisory is a specific type of CDS that appears at the point-of-care and is intended to guide physician action. [7][8][9][10][11] One opportunity to improve quality of ophthalmology care and implement a CDS tool is the identification of patients with vision impairment to facilitate referral to low vision rehabilitation (LVR) services. LVR services improve functional ability (e.g.…”

“… 2 – 6 A best practice advisory is a specific type of CDS that appears at the point-of-care and is intended to guide physician action. 7 – 11 …”

Implementation Science to Increase Adoption of Genomic Medicine: An Urgent Need

“…However, adoption of genomic medicine in clinical practice remains a work in progress [ 3 , 4 ]. HCPs support such adoption [ 5 ], but may be constrained by several factors including lack of genomics knowledge and training, a paucity of electronic health record (EHR)-based digital tools for genomics, and the burden of EHR documentation [ 6 , 7 ]. To identify potential barriers to effective genomic medicine integration in diverse settings, Obeng et al surveyed 285 physicians at the Implementing GeNomics In pracTicE (IGNITE) sites [ 3 ].…”

“…In a study to develop a CDS tool for familial hypercholesterolemia, a prevalent and monogenic disorder, input was sought from HCPs on CDS content, layout, and clinical integration. The study findings illustrated some of the challenges that are encountered during genomic medicine implementation: HCPs were unable to distinguish genetic from non-genetic hypercholesterolemia, they lacked confidence in ordering appropriate genetic testing for patients, and experienced difficulties in locating genomic resources such as relevant order sets, decision aids, and patient education materials in the EHR [ 7 ]. These results highlight the value of engaging with stakeholders such as HCPs early in the process of digital tool development to identify barriers.…”

“…An intelligent EHR could display relevant tools and auto-populate them with pertinent information during clinical encounters so that HCPs can spend more time interacting with patients rather than with the EHR [ 15 ]. Grand rounds, departmental meetings, and electronic newsletters, along with specific education modules and interactive sessions, are some of the strategies that can be used to promote knowledge dissemination among HCPs [ 7 , 16 ]. Providing easily accessible technical support is also likely to increase tool use and enhance HCP satisfaction.…”