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Appl Clin Inform 2024; 15(05): 1097-1106
DOI: 10.1055/s-0044-1791816
Research Article

A Clinical Decision Support System for Addressing Health-Related Social Needs in Emergency Department: Defining End User Needs and Preferences

Olena Mazurenko 
1   Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States
2   Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, United States
,
Adam T. Hirsh
3   School of Science, Indiana University, Indianapolis, Indiana, United States
,
Christopher A. Harle 
1   Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States
4   Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States
,
Cassidy McNamee
1   Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States
,
Joshua R. Vest 
1   Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States
4   Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States
› Author Affiliations Funding This work was supported by the Agency for Healthcare Research and Quality 1R01HS028008 (PI: J.R.V.).
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Abstract

Background Health-related social needs (HRSNs) are the unmet social and economic needs (e.g., housing instability) that affect individuals' health and well-being. HRSNs are associated with more emergency department (ED) visits, longer stays, and worse health outcomes. More than a third of ED patients have at least one HRSN, yet patients are rarely screened for HRSNs in the ED. A clinical decision support (CDS) system with predictive modeling offers a promising approach to identifying patients systematically and efficiently with HRSNs in the ED.

Objective This study aimed to identify ED clinician and staff preferences for designing and implementing an HRSN-related CDS system.

Methods A multistep, user-centered design study involving qualitative semistructured interviews, observations of ED workflows, and a multidisciplinary design workshop.

Results We conducted 16 semistructured interviews with ED clinicians and staff. Following the interviews, three research team members observed ED workflows, focusing on patient entry and clinician and staff usage of the electronic health record (EHR) system. Finally, we conducted a 3-hour multidisciplinary design workshop. An HRSN-related CDS system should be visually appealing, color-coordinated, and easily accessible in the EHR. An HRSN-related CDS system should target a select group of ED patients (to be discharged from the ED) and highlight a select set of critical HRSN issues early in the workflow to adjust clinical care adequately. An HRSN-related CDS system should provide a list of actions and the ability to notify the clinical team if the patient's HRSNs were addressed.

Conclusion The user-centered design identified a set of specific preferences for an HRSN-related CDS system to be implemented in the ED. Future work will focus on implementing and refining the CDS system and assessing the rates of changes in clinical care (e.g., rates of referrals) to address patient HRSNs in the ED.

Keywords

health-related social needs - clinical decision support system - emergency department - user-centered design

Protection of Human Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by Indiana University Institutional Review Board.


Supplementary Material



Publication History

Received: 20 May 2024

Accepted: 04 September 2024

Article published online:
18 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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