TY - JOUR
T1 - Clinical Decision Support for Worker Health
T2 - A Five-Site Qualitative Needs Assessment in Primary Care Settings
AU - Ash, Joan S.
AU - Chase, Dian
AU - Baron, Sherry
AU - Filios, Margaret S.
AU - Shiffman, Richard N.
AU - Marovich, Stacey
AU - Wiesen, Jane
AU - Luensman, Genevieve B.
N1 - Funding Information:
The aims of the parent project, funded by the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC), were to design, develop, and pilot CDS for improving the health of working patients in primary care settings. The parent study design phase included prior development of three knowledge resources (KRs) containing evidence-based information, decision logic, scenarios, and examples of use as step one. Step two was fieldwork to assess need and provide feedback, which is the focus of this paper.
Funding Information:
This project was supported by CDC/NIOSH Contract 200– 2015–61837 as part of NORA project no.: 927ZLDN. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Publisher Copyright:
© 2020 Georg Thieme Verlag. All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background ?Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective ?This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods ?We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results ?We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion ?We discovered several themes not previously described that can guide future CDS development: Technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.
AB - Background ?Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective ?This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods ?We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results ?We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion ?We discovered several themes not previously described that can guide future CDS development: Technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.
KW - attitude to computers
KW - clinical decision support
KW - hospital information systems
KW - occupational health
KW - physician order entry
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U2 - 10.1055/s-0040-1715895
DO - 10.1055/s-0040-1715895
M3 - Article
C2 - 32998170
AN - SCOPUS:85092233069
SN - 1869-0327
VL - 11
SP - 635
EP - 643
JO - Applied Clinical Informatics
JF - Applied Clinical Informatics
IS - 4
ER -