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
