Human-centred design processes for clinical decision support: A pulmonary embolism case study.

BACKGROUND: Clinical Decision Support Systems (CDSS) can make patient care more efficient, cost-effective, and guideline-concordant. Many are created by clinicians who understand the challenges, but may publish concepts before considering subtle but important design details. Human-Centred Design (HCD) approaches provide necessary methods ensuring solid CDSS design. This article highlights HCD approaches in a pulmonary embolism CDSS case study context. METHODS: This pulmonary embolism CDSS results from collaborative work between computer science, psychology, and medicine. HCD methods used include: evaluations of pre-clinical prototype recordings, iterative usability expert reviews with software refinement, formative usability testing, and (separately-published) clinical pilot study. RESULTS: HCD methods were instrumental in iteratively creating an easy to use and functionally-sound CDSS. Retrospective evaluations revealed that participants spent considerable time on items that were out of order from natural cognitive diagnostic workflows. Features missing between original and study version were noted, confusing interface elements reworked, and currently-active decision tree branches were visually emphasized. From iterative usability reviews, positioning of information within the decision tree was radically reworked, information separated into levels of support for different user groups, and supportive versus directive language issues addressed. Formative studies identified issues such as interface adjustments and hospital workflow integration. CONCLUSIONS: Human-centred design approaches provide methods for integrating the skills and knowledge of many disciplines, illustrated by example in this pulmonary embolism CDSS creation. Advantages of leveraging many design guidelines as well as revealing new design considerations that would otherwise have remained hidden are described. The findings reported here support future CDSS design through HCD inclusion.

Translating research into practice through user-centered design: An application for osteoarthritis healthcare planning.

OBJECTIVE: To identify the needs and requirements of the end users, to inform the development of a user-interface to translate an existing evidence-based decision support tool into a practical and usable interface for health service planning for osteoarthritis (OA) care. MATERIALS AND METHODS: We used a user-centered design (UCD) approach that emphasized the role of the end-users and is well-suited to knowledge translation (KT). The first phase used a needs assessment focus group (n=8) and interviews (n=5) with target users (health care planners) within a provincial health care organization. The second phase used a participatory design approach, with two small group sessions (n=6) to explore workflow, thought processes, and needs of intended users. RESULTS: The needs assessment identified five design recommendations: ensuring the user-interface supports the target user group, allowing for user-directed data explorations, input parameter flexibility, clear presentation, and provision of relevant definitions. The second phase identified workflow insights from a proposed scenario. Graphs, the need for a visual overview of the data, and interactivity were key considerations to aid in meaningful use of the model and knowledge translation. CONCLUSION: A UCD approach is well suited to identify health care planners' requirements when using a decision support tool to improve health service planning and management of OA. We believe this is one of the first applications to be used in planning for health service delivery. We identified specific design recommendations that will increase user acceptability and uptake of the user-interface and underlying decision support tool in practice. Our approach demonstrated how UCD can be used to enable knowledge translation.