Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

Abstract

Background Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

Exploring the role of professional identity in the implementation of clinical decision support systems—a narrative review

“… Factors encountered less than 10 times: Organizational: Champions as mediators between professions and facilitators of knowledge ( n = 8) [ 24 , 70 , 82 , 92 , 99 , 166 , 169 , 174 ], Social influence ( n = 8) [ 100 , 143 , 148 , 154 , 159 , 161 , 172 , 182 ], System implementation costs ( n = 4) [ 89 , 94 , 165 , 174 ], Organization size ( n = 4) [ 104 , 118 , 150 , 189 ]; Environmental: Governmental policies and guidelines, incl. misleading guidelines and tight control ( n = 7) [ 90 , 117 , 123 , 126 , 146 , 152 , 174 ], National funding ( n = 3) [ 10 , 123 , 174 ], External competition ( n = 2) [ 139 , 169 ], Broadband connection ( n = 1) [ 10 ], CDSS misused for political bargaining ( n = 1) [ 123 ]; Human: Collaboration and trust between all involved ( n = 7) [ 5 , 10 , 24 , 86 , 97 , 134 , 174 ], Age ( n = 6) [ 83 , 84 , 105 , 140 ...…”

A systematic review of the methods used to ensure rigour, transparency and validity in rapid evaluations, rapid appraisals and rapid assessments

“…Inconsistency in data collection methods and data analysis methods, due to not having the time to train team members or having the time for supervisors to attend all data collection to ensure alignment across team members, were identified as challenges in the rapid studies (Ash et al, 2016; Bayleyegn et al, 2006). Methods such as team debriefings at the end of each day of data collection or during data analysis were used frequently across the included literature for team members to share feedback with each other to ensure consistency with the methods they have and continue to use.…”

Nothing for Me or About Me, Without Me: Codesign of Clinical Decision Support

“…One of our key limitations was the lack of a published framework to measure meaningful patient and caregiver engagement during CDS design (e.g., recognition of the need for appropriateness to CDS for patients, but not necessarily including patients). 17 Recently, AHRQ launched the CDSiC, which has several patient activists in key roles to advance a research agenda for measuring trust and patient-centeredness of CDS, among other important areas in the field of CDS. If successful, the CDSiC will build upon the approaches described here and will provide a measurement framework to study the impact of participatory, patient-centered design of CDS.…”