Local, Early, and Precise: Designing a Clinical Decision Support System for Child and Adolescent Mental Health Services

Abstract

Mental health disorders often develop during childhood and adolescence, causing long term and debilitating impacts at individual and societal levels. Local, early, and precise assessment and evidence-based treatment are key to achieve positive mental health outcomes and to avoid long-term care. Technological advancements, such as computerized Clinical Decision Support Systems (CDSSs), can support practitioners in providing evidence-based care. While previous studies have found CDSS implementation helps to improve aspects of medical care, evidence is limited on its use for child and adolescent mental health care. This paper presents challenges and opportunities for adapting CDSS design and implementation to child and adolescent mental health services (CAMHS). To highlight the complexity of incorporating CDSSs within local CAMHS, we have structured the paper around four components to consider before designing and implementing the CDSS: supporting collaboration among multiple stakeholders involved in care; optimally using health data; accounting for comorbidities; and addressing the temporality of patient care. The proposed perspective is presented within the context of the child and adolescent mental health services in Norway and an ongoing Norwegian innovative research project, the Individualized Digital DEcision Assist System (IDDEAS), for child and adolescent mental health disorders. Attention deficit hyperactivity disorder (ADHD) among children and adolescents serves as the case example. The integration of IDDEAS in Norway intends to yield significantly improved outcomes for children and adolescents with enduring mental health disorders, and ultimately serve as an educational opportunity for future international approaches to such CDSS design and implementation.

Attitudes of Mental Health Service Users Toward Storage and Use of Electronic Health Records

“…In other words, for them, benefits outweighed concerns. This finding supports EHR data use for the development of future systems to improve efficiency and quality of mental health care through technological advancements, including CDSSs (24,25,[30][31][32].…”

Usability of the IDDEAS prototype in child and adolescent mental health services: A qualitative study for clinical decision support system development

“…Our experimental procedures allowed the clinicians to reflect on IDDEAS and suggest what could be better or different. While there was limited patient information and an inability to interact with a fully formed CDSS, the study allowed for us to learn about clinicians' preferences with respect to what they need and do not need from the CDSS in CAMHS and EHR integration (38). Similarly, other CDSS development studies that have used hypothetical case scenarios found similar limitations dependent upon the state of the CDSS prototype but still identified important takeaways for the systems further development, including close integration of the patient information from the EHR (31).…”

“…The results suggest that several attributes of the IDDEAS prototype should be addressed in the next version of IDDEAS (see Table 1). For the development of IDDEAS following UCD methods and an overall iterative approach (11,30), we expect 10.3389/fpsyt.2023.1033724 continued identification of usability barriers and limitations to the design of IDDEAS, as seen commonly in other CDSS development studies (25,38,42,43). For example, as similarly found by Baysari et al (30) or Giordanengo et al (43), it is important to design the system from the perspective of the end-user and finding overall improved perceptions of the system usability with the wellintegrated EHR (44).…”

Success Factors of an Early EHR System for Child and Adolescent Mental Health: Lessons Learned for Future Practice Data-Driven Decision Aids

“…The findings are based on both, the study of software artifacts, as well as interviews held with system designers, managers, secretaries, data users, and other stakeholders. The objective of this study is to develop guidelines and requirements for the IDDEAS [9] project, which aims to develop CAMHS-specific decision aids integrated in general EHR systems [8,10].…”