Scoping review of dashboards in health care: why, how, and for whom they have been developed, implemented, and evaluated (Preprint)

Abstract

BACKGROUND While dashboards are frequently used by health systems to monitor and improve performance, little is known about their characteristics and the processes used to incorporate them into practice. OBJECTIVE This scoping review aimed to explore published literature on health care dashboards to summarize why, how, and for whom they have been developed, implemented, and evaluated. METHODS MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched from inception through July 2020. Studies were included if they described the development or evaluation of a health care dashboard with publication since 2015. Clinical setting, purpose (categorized as clinical, administrative, or both), and end-user were extracted for all studies. Data on dashboard development, design characteristics, implementation strategies, and evaluation were extracted only for studies published from 2018-2020. RESULTS Data was extracted for 199 dashboards described in 193 publications. The most common settings in which dashboards were used were inpatient (n=81/199, 40.7%) and outpatient clinics (n=68/199, 34.2%). Most dashboards had ≥2 stated purposes (n=142/199, 71.4%); of these, 97/199 (48.7%) were administrative, 68/199 (34.2%) were clinical, and 31/199 (15.6%) met both criteria. Most dashboards included front-line clinical staff as end-users (n=154/199, 77.4%). In the 118 dashboards published from 2018-2020, half involved end-users in the design process (n=59/118, 50.0%); fewer described formative usability testing (n=26/118, 22.0%) or use of any theory or framework to guide development, implementation, or evaluation (n=24/118, 20.3%). Dashboards tended to be web-based (n=41/118, 34.7%) or embedded directly into the electronic health record (n=17/118, 14.4%). Common implementation strategies used alongside dashboards included education (n=60/118, 50.8%), audit and feedback (n=59/118, 50.0%), and advisory boards (n=54/118, 45.8%). Evaluations of dashboards (n=84/118, 71.2%) were mostly quantitative (n=60/118, 50.8%), or mixed methods, combining dashboard or health record data with qualitative findings (n=18/118, 15.2%). CONCLUSIONS Dashboards in health care have been used in diverse settings, for multiple purposes and varied end users. The complexity of many dashboards – serving many purposes and end users at once – and the frequent expectation that clinicians will use them underscores the importance of systematic design and evaluation to ensure they are having the intended outcomes. Future work is needed to identify best practices for the development, implementation, and evaluation of health care dashboards. INTERNATIONAL REGISTERED REPORT RR2-10.2196/34894