Clinical Decision Support (CDS)

Significance  

Clinical Decision Support (CDS) is a category of software that assists doctors and other healthcare providers with important diagnostic and treatment decisions for patients. The use of CDS can increase diagnostic accuracy, reduce unnecessary testing and treatments, and increase the quality and safety of healthcare.

For more than a decade, the Usability Lab at the Northwell Health Center for Health Innovations and Outcomes Research (CHIOR) has been developing, testing, validating, and evaluating CDS tools and systems. While our work has helped improve clinical outcomes in targeted settings, the broad impact of CDS has been severely limited by low rates of provider adoption, reported overall at 10% − 20%. As useful as CDS may be, our research shows that in many cases, users tend to ignore or skip over CDS functionality when it’s offered, often because the specific tools are difficult to use and time intensive.

The primary focus of the Usability Lab’s CDS work is on implementing, studying, and disseminating CDS that achieves higher levels of user adoption.

Methods

The Usability Lab was created in 2013 as a result of a grant to Dr. Thomas G. McGinn from the federal Agency for Healthcare Rsearch and Quality (AHRQ). The Lab’s purpose was to bring a dedicated focus on human centered design and usability to Dr. McGinn’s CDS research projects. At the time, this research was focused on using CDS to help doctors avoid over-prescribing antibiotic medication, a significant public health issue.

Tool development was guided by the principles of human centered design and the agile method. Human centered design is a mindset that adopts the end user’s perspective and needs from the very beginning of the conceptualization process. Whereas a traditional design approach might ask the question, “Which features should we add to our software?”, human centered design asks, “What kinds of problems do our users encounter that we can help solve?”

The agile method is a process and design philosophy that emphasizes tight bursts of productivity, called “sprints”, coupled with immediate end user feedback, followed by iterative cycles of sprinting and evaluation. In contrast, the more traditional “waterfall” method of development entails fully defining every aspect of a product at the outset, and then embarking on a large, singular effort to build it without feedback during the development process. With the agile method, compared to the waterfall approach, projects move at a more predictable pace and evolve to provide features and capabilities that might not become apparent until the middle of the project.

Results

The Usability Lab has helped with the development process for CDS tools for a range of clinical purposes, ranging from antibiotic prescribing to anticoagulation to child abuse detection to Coronavirus Disease-2019 (COVID-19) survival prediction and beyond. These tools have been studied by the Usability Lab to optimize use, resulting in adoption rates as high as 60-70%.

Conclusions

CDS software is an important tool that doctors and other healthcare providers can use to increase diagnostic accuracy, reduce unnecessary testing and treatments, and increase the quality and safety of healthcare. However, due in large part to poor usability, users only choose to use CDS software between 10% and 20% of the time they are given the opportunity.

Through the development and application of rigorous protocols for human centered design, agile development, and usability testing, the Usability Lab helps guide the development of CDS that is more usable and, ultimately, more highly adopted.