Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review

Abstract

Background Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow. Methods A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed. Results The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. Of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”. Conclusions The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.

Barriers and facilitators to utilizing digital health technologies by healthcare professionals

“…Most studies did not precisely consider one medical specialty, disease, or condition. However, some reviews focused on diseases of the respiratory system (e.g., tuberculosis, asthma, and chronic pulmonary obstructive disease) 19 , 22 , 31 , 32 , 46 , 93 , 101 , 123 , pregnancy, childbirth, or puerperium (e.g., maternal health, postpartum hemorrhage, and reproductive health) 19 , 22 , 23 , 26 , 31 , 35 , 46 , 56 , 61 , 77 , 94 , certain infectious or parasitic diseases (e.g., malaria, human immunodeficiency virus infection, and influenza) 19 , 22 , 23 , 28 , 31 , 46 , 50 , 61 , endocrine, nutritional, or metabolic diseases (e.g., diabetes mellitus) 57 , 64 , 76 , 93 , 123 , mental and behavioral disorders (e.g., post-traumatic disorder syndrome, stress, depression, and burnout) 23 , 41 , 44 , 64 , 70 , 76 , 94 , 125 , neoplasms 50 , 67 , 85 , 123 , diseases of the circulatory system (e.g., hypertension) 19 , 25 , 48 , 50 , 57 , 67 , 93 , 123 , diseases of the blood or blood-forming organs (e.g., anemia) 22 , and diseases or disorders of orofacial complex (e.g., oral lesions) 28 , 42 . Identified reviews mostly included quantita...…”

Trialling a Large Language Model (ChatGPT) in General Practice With the Applied Knowledge Test: Observational Study Demonstrating Opportunities and Limitations in Primary Care

“…Additionally, uncertainty indicators or contingency messages where the model is unable to answer with accuracy could improve confidence in the information provided and, therefore, safety [ 19 , 20 ]. Specific study is required to ensure that new tools reduce rather than increase workload for GPs [ 23 - 25 ]. As this technology continues to advance, individualistic care must not be sacrificed: general practice consulting involves long-term development of a therapeutic relationship between patients and physicians, and chatbots should not be allowed to change this dynamic into an impersonal, transactional arrangement [ 21 , 24 ].…”

Is the early identification and referral of suspected head and neck cancers by community pharmacists feasible? A qualitative interview study exploring the views of patients in North East England

“…The data suggested that the idea of using a symptom‐based risk calculator was good if it would help earlier identification or referral, although research is yet to identify if clinical decision‐making tools are disruptive to consultation times, increasing them to an inappropriate degree 27 . Furthermore, the calculator does not include premalignant oral conditions such as leukoplakia, erythroplakia and oral lichen planus.…”

“…The data suggested that the idea of using a symptom-based risk calculator was good if it would help earlier identification or referral, although research is yet to identify if clinical decision-making tools are disruptive to consultation times, increasing them to an inappropriate degree. 27 Furthermore, the calculator does not include premalignant oral conditions such as leukoplakia, erythroplakia and oral lichen planus. Notwithstanding, for cancer symptoms such as an ulcer or a croaky voice, the calculator would result in the recommendation of an urgent referral if the symptoms were persistent and unexplained, even with an absence of a history of smoking or excess alcohol consumption.…”