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Awad S, Amon K, Baillie A, Loveday T, Baysari MT. Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: A systematic review. Int J Med Inform 2023; 172:105017. [PMID: 36809716 DOI: 10.1016/j.ijmedinf.2023.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/15/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Poorly designed electronic medication management systems (EMMS) or computerized physician order entry (CPOE) systems in hospital settings can result in usability issues and in turn, patient safety risks. As a safety science, human factors and safety analysis methods have potential to support the safe and usable design of EMMS. OBJECTIVE To identify and describe human factors and safety analysis methods that have been used in the design or redesign of EMMS used in hospital settings. MATERIALS AND METHODS A systematic review, following PRISMA guidelines, was conducted by searching online databases and relevant journals from January 2011 to May 2022. Studies were included if they described the practical application of human factors and safety analysis methods to support the design or redesign of a clinician-facing EMMS, or its components. Methods used were extracted and mapped to human centered design (HCD) activities: understanding context of use; specifying user requirements; producing design solutions; and evaluating the design. RESULTS Twenty-one papers met the inclusion criteria. Overall, 21 human factors and safety analysis methods were used in the design or redesign of EMMS with prototyping, usability testing, participant surveys/questionnaires and interviews the most frequent. Human factors and safety analysis methods were most frequently used to evaluate the design of a system (n = 67; 56.3%). Nineteen of 21 (90%) methods used aimed to identify usability issues and/or support iterative design; only one paper utilized a safety-oriented method and one, a mental workload assessment method. DISCUSSION AND CONCLUSION While the review identified 21 methods, EMMS design primarily utilized a subset of available methods, and rarely a method focused on safety. Given the high-risk nature of medication management in complex hospital environments, and the potential for harm due to poorly designed EMMS, there is significant potential to apply more safety-oriented human factors and safety analysis methods to support EMMS design.
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Affiliation(s)
- Selvana Awad
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; eHealth NSW, Australia.
| | - Krestina Amon
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Andrew Baillie
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Australia; Sydney Local Health District, Australia
| | | | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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2
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Garabedian PM, Gannon MP, Aaron S, Wu E, Burns Z, Samal L. Human-centered design of clinical decision support for management of hypertension with chronic kidney disease. BMC Med Inform Decis Mak 2022; 22:217. [PMID: 35964083 PMCID: PMC9375189 DOI: 10.1186/s12911-022-01962-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Primary care providers face challenges in recognizing and controlling hypertension in patients with chronic kidney disease (CKD). Clinical decision support (CDS) has the potential to aid clinicians in identifying patients who could benefit from medication changes. This study designed an alert to control hypertension in CKD patients using an iterative human-centered design process. Methods In this study, we present a human-centered design process employing multiple methods for gathering user requirements and feedback on design and usability. Initially, we conducted contextual inquiry sessions to gather user requirements for the CDS. This was followed by group design sessions and one-on-one formative think-aloud sessions to validate requirements, obtain feedback on the design and layout, uncover usability issues, and validate changes. Results This study included 20 participants. The contextual inquiry produced 10 user requirements which influenced the initial alert design. The group design sessions revealed issues related to several themes, including recommendations and clinical content that did not match providers' expectations and extraneous information on the alerts that did not provide value. Findings from the individual think-aloud sessions revealed that participants disagreed with some recommended clinical actions, requested additional information, and had concerns about the placement in their workflow. Following each step, iterative changes were made to the alert content and design. Discussion This study showed that participation from users throughout the design process can lead to a better understanding of user requirements and optimal design, even within the constraints of an EHR alerting system. While raising awareness of design needs, it also revealed concerns related to workflow, understandability, and relevance. Conclusion The human-centered design framework using multiple methods for CDS development informed the creation of an alert to assist in the treatment and recognition of hypertension in patients with CKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01962-y.
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Affiliation(s)
- Pamela M Garabedian
- Mass General Brigham, 399 Revolution Drive, Somerville, MA, 857-282-4091, USA.
| | - Michael P Gannon
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Skye Aaron
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward Wu
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Zoe Burns
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lipika Samal
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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3
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Improving the usability and usefulness of computerized decision support systems for medication review by clinical pharmacists: A convergent, parallel evaluation. Res Social Adm Pharm 2022; 19:144-154. [DOI: 10.1016/j.sapharm.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/09/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
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Khowaja K, Syed WW, Singh M, Taheri S, Chagoury O, Al-Thani D, Aupetit M. A Participatory Design Approach to Develop Visualization of Wearable Actigraphy Data for Health Care Professionals: Case Study in Qatar. JMIR Hum Factors 2022; 9:e25880. [PMID: 35394442 PMCID: PMC9034423 DOI: 10.2196/25880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several tools have been developed for health care professionals to monitor the physical activity of their patients, but most of these tools have been considering only the needs of users in North American and European countries and applicable for only specific analytic tasks. To our knowledge, no research study has utilized the participatory design (PD) approach in the Middle East region to develop such tools, involving all the stakeholders in the product development phases, and no clear use cases have been derived from such studies that could serve future development in the field. Objective This study aims to develop an interactive visualization tool (ActiVis) to support local health care professionals in monitoring the physical activity of their patients measured through wearable sensors, with the overall objective of improving the health of the Qatari population. Methods We used PD and user-centered design methodologies to develop ActiVis, including persona development, brainwriting, and heuristic walkthrough as part of user evaluation workshops; and use cases, heuristic walkthrough, interface walkthrough, and survey as part of expert evaluation sessions. Results We derived and validated 6 data analysis use cases targeted at specific health care professionals from a collaborative design workshop and an expert user study. These use cases led to improving the design of the ActiVis tool to support the monitoring of patients’ physical activity by nurses and family doctors. The ActiVis research prototype (RP) compared favorably with the Fitbit Dashboard, showing the importance of design tools specific to end users’ needs rather than relying on repurposing existing tools designed for other types of users. The use cases we derived happen to be culturally agnostic, despite our assumption that the local Muslim and Arabic culture could impact the design of such visualization tools. At last, taking a step back, we reflect on running collaborative design sessions in a multicultural environment and oil-based economy. Conclusions Beyond the development of the ActiVis tool, this study can serve other visualization and human–computer interaction designers in the region to prepare their design projects and encourage health care professionals to engage with designers and engineers to improve the tools they use for supporting their daily routine. The development of the ActiVis tool for nurses, and other visualization tools specific to family doctors and clinician researchers, is still ongoing and we plan to integrate them into an operational platform for health care professionals in Qatar in the near future.
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Affiliation(s)
- Kamran Khowaja
- Information and Computing Technology Division, College of Science and Engineering, Hamad Bin Khalifa University, Education City, Qatar.,Department of Computer Science, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Hyderabad, Pakistan
| | - Wafa Waheeda Syed
- Social Computing, Qatar Computing Research Institute, Hamad Bin Khalifa University, Education City, Qatar
| | - Meghna Singh
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine, New York, NY, United States.,National Obesity Treatment Center, Qatar Metabolic Institute, Doha, Qatar
| | - Odette Chagoury
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine, New York, NY, United States.,National Obesity Treatment Center, Qatar Metabolic Institute, Doha, Qatar
| | - Dena Al-Thani
- Information and Computing Technology Division, College of Science and Engineering, Hamad Bin Khalifa University, Education City, Qatar
| | - Michaël Aupetit
- Social Computing, Qatar Computing Research Institute, Hamad Bin Khalifa University, Education City, Qatar
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Daignault C, Sauer HE, Lindsay H, Alonzo A, Foster J. Investigating Potential Drug-Drug Interactions in Pediatric and Adolescent Patients Receiving Chemotherapy. J Oncol Pharm Pract 2022; 28:904-909. [PMID: 35179058 DOI: 10.1177/10781552221079786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pediatric and adolescent oncology patients admitted to receive chemotherapy are at risk for drug-drug interactions (DDI). While adult literature has quoted this risk to be as high as 95% of encounters, the literature in pediatrics is limited. This is a single-center, retrospective chart review of DDI in hospitalized pediatric oncology patients. METHODS All patients admitted to Texas Children's Hospital for chemotherapy were included. Medications ordered during the hospitalization were evaluated by Lexicomp® Drug Interactions Tool. Interactions classified as D or X or interactions rated a C including a chemotherapeutic agent were independently reviewed by three clinicians for clinical relevance. Medications associated with central nervous system (CNS) depression or QTc prolongation were counted separately. RESULTS Of 100 admissions evaluated, 100% had a flagged interaction. There were a total of 12 X-rated interactions, 8 D-rated interactions, and 12 C-rated interactions with a chemotherapeutic agent found to be clinically relevant. Thirty-three percent of admissions had 4 or more QTc prolonging medications ordered. Twenty-four percent of admissions had 3 or more prescribed CNS depressants. In total 49% of admissions were found to have at least 1 clinically-significant DDI. CONCLUSIONS This study exemplifies the risk of drug-drug interactions in children and young adults admitted to the hospital for chemotherapy. We demonstrated a high rate of flagged interactions with about half of admissions found to have a potentially clinically-significant DDI. Concomitant use of multiple QTc prolonging and CNS depressant medications was also prevalent, indicating a need to evaluate monitoring practices.
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Affiliation(s)
- Chelsea Daignault
- 506057Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Hannah E Sauer
- Department of Pharmacy, 3984Texas Children's Hospital, Houston, TX, United States
| | - Holly Lindsay
- 506057Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Amy Alonzo
- Department of Pharmacy, 3984Texas Children's Hospital, Houston, TX, United States
| | - Jennifer Foster
- 506057Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
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Elchynski AL, Desai N, D’Silva D, Hall B, Marks Y, Wiisanen K, Cicali EJ, Cavallari LH, Nguyen KA. Utilizing a Human-Computer Interaction Approach to Evaluate the Design of Current Pharmacogenomics Clinical Decision Support. J Pers Med 2021; 11:jpm11111227. [PMID: 34834578 PMCID: PMC8618963 DOI: 10.3390/jpm11111227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 01/14/2023] Open
Abstract
A formal assessment of pharmacogenomics clinical decision support (PGx-CDS) by providers is lacking in the literature. The objective of this study was to evaluate the usability of PGx-CDS tools that have been implemented in a healthcare setting. We enrolled ten prescribing healthcare providers and had them complete a 60-min usability session, which included interacting with two PGx-CDS scenarios using the “Think Aloud” technique, as well as completing the Computer System Usability Questionnaire (CSUQ). Providers reported positive comments, negative comments, and suggestions for the two PGx-CDS during the usability testing. Most provider comments were in favor of the current PGx-CDS design, with the exception of how the genotype and phenotype information is displayed. The mean CSUQ score for the PGx-CDS overall satisfaction was 6.3 ± 0.95, with seven strongly agreeing and one strongly disagreeing for overall satisfaction. The implemented PGx-CDS at our institution was well received by prescribing healthcare providers. The feedback collected from the session will guide future PGx-CDS designs for our healthcare system and provide a framework for other institutions implementing PGx-CDS.
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Affiliation(s)
- Amanda L. Elchynski
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL 32611, USA
- Arkansas Children’s Hospital, Little Rock, AR 72202, USA
| | - Nina Desai
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
| | - Danielle D’Silva
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
| | - Bradley Hall
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
| | - Yael Marks
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
| | - Kristin Wiisanen
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Emily J. Cicali
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Khoa A. Nguyen
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (A.L.E.); (N.D.); (D.D.); (B.H.); (Y.M.); (K.W.); (E.J.C.); (L.H.C.)
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL 32611, USA
- Correspondence:
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Wake DT, Smith DM, Kazi S, Dunnenberger HM. Pharmacogenomic Clinical Decision Support: A Review, How-to Guide, and Future Vision. Clin Pharmacol Ther 2021; 112:44-57. [PMID: 34365648 PMCID: PMC9291515 DOI: 10.1002/cpt.2387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023]
Abstract
Clinical decision support (CDS) is an essential part of any pharmacogenomics (PGx) implementation. Increasingly, institutions have implemented CDS tools in the clinical setting to bring PGx data into patient care, and several have published their experiences with these implementations. However, barriers remain that limit the ability of some programs to create CDS tools to fit their PGx needs. Therefore, the purpose of this review is to summarize the types, functions, and limitations of PGx CDS currently in practice. Then, we provide an approachable step‐by‐step how‐to guide with a case example to help implementers bring PGx to the front lines of care regardless of their setting. Particular focus is paid to the five “rights” of CDS as a core around designing PGx CDS tools. Finally, we conclude with a discussion of opportunities and areas of growth for PGx CDS.
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Affiliation(s)
- Dyson T Wake
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - D Max Smith
- MedStar Health, Columbia, Maryland, USA.,Georgetown University Medical Center, Washington, DC, USA
| | - Sadaf Kazi
- Georgetown University Medical Center, Washington, DC, USA.,National Center for Human Factors in Healthcare, MedStar Health Research Institute Washington, Washington, DC, USA
| | - Henry M Dunnenberger
- Mark R. Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
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Keeling NJ, Dunn TJ, Bentley JP, Ramachandran S, Hoffman JM, Rosenthal M. Approaches to assessing the provider experience with clinical pharmacogenomic information: a scoping review. Genet Med 2021; 23:1589-1603. [PMID: 33927377 DOI: 10.1038/s41436-021-01186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/11/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Barriers to the implementation of pharmacogenomics in clinical practice have been thoroughly discussed over the past decade. METHODS The objective of this scoping review was to characterize the peer-reviewed literature surrounding the experiences and actions of prescribers, pharmacists, or genetic counselors when using pharmacogenomic information in real-world or hypothetical research settings. RESULTS A total of 33 studies were included in the scoping review. The majority of studies were conducted in the United States (70%), used quantitative or mixed methods (79%) with physician or pharmacist respondents (100%). The qualitative content analysis revealed five major methodological approaches: hypothetical clinical case scenarios, real-world studies evaluating prescriber response to recommendations or alerts, cross-sectional quantitative surveys, cross-sectional qualitative surveys/interviews, and a quasi-experimental real-world study. CONCLUSION The findings of this scoping review can guide further research on the factors needed to successfully integrate pharmacogenomics into clinical care.
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Affiliation(s)
- Nicholas J Keeling
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
| | - Tyler J Dunn
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.
| | - John P Bentley
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
| | - James M Hoffman
- Department of Pharmaceutical Sciences and Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Meagen Rosenthal
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
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Schaaf J, Sedlmayr M, Schaefer J, Storf H. Diagnosis of Rare Diseases: a scoping review of clinical decision support systems. Orphanet J Rare Dis 2020; 15:263. [PMID: 32972444 PMCID: PMC7513302 DOI: 10.1186/s13023-020-01536-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rare Diseases (RDs), which are defined as diseases affecting no more than 5 out of 10,000 people, are often severe, chronic and life-threatening. A main problem is the delay in diagnosing RDs. Clinical decision support systems (CDSSs) for RDs are software systems to support clinicians in the diagnosis of patients with RDs. Due to their clinical importance, we conducted a scoping review to determine which CDSSs are available to support the diagnosis of RDs patients, whether the CDSSs are available to be used by clinicians and which functionalities and data are used to provide decision support. METHODS We searched PubMed for CDSSs in RDs published between December 16, 2008 and December 16, 2018. Only English articles, original peer reviewed journals and conference papers describing a clinical prototype or a routine use of CDSSs were included. For data charting, we used the data items "Objective and background of the publication/project", "System or project name", "Functionality", "Type of clinical data", "Rare Diseases covered", "Development status", "System availability", "Data entry and integration", "Last software update" and "Clinical usage". RESULTS The search identified 636 articles. After title and abstracting screening, as well as assessing the eligibility criteria for full-text screening, 22 articles describing 19 different CDSSs were identified. Three types of CDSSs were classified: "Analysis or comparison of genetic and phenotypic data," "machine learning" and "information retrieval". Twelve of nineteen CDSSs use phenotypic and genetic data, followed by clinical data, literature databases and patient questionnaires. Fourteen of nineteen CDSSs are fully developed systems and therefore publicly available. Data can be entered or uploaded manually in six CDSSs, whereas for four CDSSs no information for data integration was available. Only seven CDSSs allow further ways of data integration. thirteen CDSS do not provide information about clinical usage. CONCLUSIONS Different CDSS for various purposes are available, yet clinicians have to determine which is best for their patient. To allow a more precise usage, future research has to focus on CDSSs RDs data integration, clinical usage and updating clinical knowledge. It remains interesting which of the CDSSs will be used and maintained in the future.
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Affiliation(s)
- Jannik Schaaf
- Medical Informatics Group (MIG), University Hospital Frankfurt, Frankfurt, Germany.
| | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine Technische Universität Dresden, Dresden, Germany
| | - Johanna Schaefer
- Medical Informatics Group (MIG), University Hospital Frankfurt, Frankfurt, Germany
| | - Holger Storf
- Medical Informatics Group (MIG), University Hospital Frankfurt, Frankfurt, Germany
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Abstract
OBJECTIVES This survey aimed to review aspects of clinical decision support (CDS) that contribute to burnout and identify key themes for improving the acceptability of CDS to clinicians, with the goal of decreasing said burnout. METHODS We performed a survey of relevant articles from 2018-2019 addressing CDS and aspects of clinician burnout from PubMed and Web of Science™. Themes were manually extracted from publications that met inclusion criteria. RESULTS Eighty-nine articles met inclusion criteria, including 12 review articles. Review articles were either prescriptive, describing how CDS should work, or analytic, describing how current CDS tools are deployed. The non-review articles largely demonstrated poor relevance and acceptability of current tools, and few studies showed benefits in terms of efficiency or patient outcomes from implemented CDS. Encouragingly, multiple studies highlighted steps that succeeded in improving both acceptability and relevance of CDS. CONCLUSIONS CDS can contribute to clinician frustration and burnout. Using the techniques of improving relevance, soliciting feedback, customization, measurement of outcomes and metrics, and iteration, the effects of CDS on burnout can be ameliorated.
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Affiliation(s)
- Ivana Jankovic
- Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan H. Chen
- Center for Biomedical Informatics Research and Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Hoffman JM, Flynn AJ, Juskewitch JE, Freimuth RR. Biomedical Data Science and Informatics Challenges to Implementing Pharmacogenomics with Electronic Health Records. Annu Rev Biomed Data Sci 2020. [DOI: 10.1146/annurev-biodatasci-020320-093614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pharmacogenomic information must be incorporated into electronic health records (EHRs) with clinical decision support in order to fully realize its potential to improve drug therapy. Supported by various clinical knowledge resources, pharmacogenomic workflows have been implemented in several healthcare systems. Little standardization exists across these efforts, however, which limits scalability both within and across clinical sites. Limitations in information standards, knowledge management, and the capabilities of modern EHRs remain challenges for the widespread use of pharmacogenomics in the clinic, but ongoing efforts are addressing these challenges. Although much work remains to use pharmacogenomic information more effectively within clinical systems, the experiences of pioneering sites and lessons learned from those programs may be instructive for other clinical areas beyond genomics. We present a vision of what can be achieved as informatics and data science converge to enable further adoption of pharmacogenomics in the clinic.
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Affiliation(s)
- James M. Hoffman
- Department of Pharmaceutical Sciences and the Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Allen J. Flynn
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Justin E. Juskewitch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Robert R. Freimuth
- Division of Digital Health Sciences, Department of Health Sciences Research, Center for Individualized Medicine, and Information and Knowledge Management, Mayo Clinic, Rochester, Minnesota 55905, USA
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