Appl Clin Inform 2013; 04(04): 618-635
DOI: 10.4338/ACI-2013-08-RA-0058
Research Article
Schattauer GmbH

Transforming User Needs into Functional Requirements for an Antibiotic Clinical Decision Support System

Explicating Content Analysis for System Design
T.J. Bright
1   Columbia University, Biomedical Informatics, New York, New York, United States
› Author Affiliations
Further Information

Correspondence to:

Tiffani J. Bright PhD
Columbia University
Department of Biomedical Informatics
622 West 168th St. VC5
New York, NY 10032

Publication History

Received: 05 August 2013

Accepted: 11 November 2013

Publication Date:
19 December 2017 (online)

 

Summary

Background: Many informatics studies use content analysis to generate functional requirements for system development. Explication of this translational process from qualitative data to functional requirements can strengthen the understanding and scientific rigor when applying content analysis in informatics studies.

Objectives: To describe a user-centered approach transforming emergent themes derived from focus group data into functional requirements for informatics solutions and to illustrate these methods to the development of an antibiotic clinical decision support system (CDS).

Methods: The approach consisted of five steps: 1) identify unmet therapeutic planning information needs via Focus Group Study-I, 2) develop a coding framework of therapeutic planning themes to refine the domain scope to antibiotic therapeutic planning, 3) identify functional requirements of an antibiotic CDS system via Focus Group Study-II, 4) discover informatics solutions and functional requirements from coded data, and 5) determine the types of information needed to support the antibiotic CDS system and link with the identified informatics solutions and functional requirements.

Results: The coding framework for Focus Group Study-I revealed unmet therapeutic planning needs. Twelve subthemes emerged and were clustered into four themes; analysis indicated a need for an antibiotic CDS intervention. Focus Group Study-II included five types of information needs. Comments from the Barrier/Challenge to information access and Function/Feature themes produced three informatics solutions and 13 functional requirements of an antibiotic CDS system. Comments from the Patient, Institution, and Domain themes generated required data elements for each informatics solution.

Conclusions: This study presents one example explicating content analysis of focus group data and the analysis process to functional requirements from narrative data. Illustration of this 5-step method was used to develop an antibiotic CDS system, resolving unmet antibiotic prescribing needs. As a reusable approach, these techniques can be refined and applied to resolve unmet information needs with informatics interventions in additional domains.

Citation: Bright TJ. Transforming user needs into functional requirements for an antibiotic clinical decision support system: explicating content analysis for system design. Appl Clin Inf 2013; 4: 618–635

http://dx.doi.org/10.4338/ACI-2013-08-RA-0058


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Conflicts of interest

The author declares that there are no conflicts of interest in the research.

  • References

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  • 2 Horsky J, Schiff GD, Johnston D, Mercincavage L, Bell D, Middleton B. Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions. Journal of biomedical informatics 2012; 45 (Suppl. 06) 1202-1216. PubMed PMID: 22995208.
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  • 5 Borycki EM, Househ M, Kushniruk AW, Kuziemsky C. Use of qualitative methods across the software development lifecycle in health informatics. Studies in health technology and informatics 2011; 164: 293-297. PubMed PMID: 21335726.
  • 6 Kushniruk A. Evaluation in the design of health information systems: application of approaches emerging from usability engineering. Computers in biology and medicine 2002; 32 (Suppl. 03) 141-149. PubMed PMID: 11922931.
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  • 13 Filice GA, Drekonja DM, Thurn JR, Rector TS, Hamann GM, Masoud BT, Leuck AM, Nordgaard CL, Eilertson MK, Johnson JR. Use of a computer decision support system and antimicrobial therapy appropriateness. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America 2013; 34 (Suppl. 06) 558-565. PubMed PMID: 23651885.
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  • 15 Litvin CB, Ornstein SM, Wessell AM, Nemeth LS, Nietert PJ. Use of an Electronic Health Record Clinical Decision Support Tool to Improve Antibiotic Prescribing for Acute Respiratory Infections: The ABX-TRIP Study. Journal of general internal medicine 2013; 28 (Suppl. 06) 810-816. PubMed PMID: 23117955. Pubmed Central PMCID: 3663943.
  • 16 Mainous AG, 3rd Lambourne CA, Nietert PJ. Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial. Journal of the American Medical Informatics Association: JAMIA 2013; 20 (Suppl. 02) 317-324. PubMed PMID: 22759620. Pubmed Central PMCID: 3638170.
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  • 19 Thomas DR. A general inductive approach for analyzing qualitative evaluation data. American journal of evaluation 2006; 27 (Suppl. 02) 237-246.
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  • 24 Wolf ZR. Exploring the audit trail for qualitative investigations. Nurse educator 2003; 28 (Suppl. 04) 175-178. PubMed PMID: 12878896.
  • 25 Chused A. Development of a taxonomy to aid management of computerized alerts. Unpublished manuscript, Department of Biomedical Informatics, Columbia University, New York, NY 2009.
  • 26 Bright TJ, Yoko Furuya E, Kuperman GJ, Cimino JJ, Bakken S. Development and evaluation of an ontology for guiding appropriate antibiotic prescribing. Journal of biomedical informatics 2012; 45 (Suppl. 01) 120-128. PubMed PMID: 22019377. Pubmed Central PMCID: 3272092.
  • 27 Jenkings KN, Wilson RG. The challenge of electronic health records (EHRs) design and implementation: responses of health workers to drawing a ‘big and rich picture’ of a future EHR programme using animated tools. Informatics in primary care 2007; 15 (Suppl. 02) 93-101. PubMed PMID: 17877871.
  • 28 Veinot TC, Campbell TR, Kruger DJ, Grodzinski A. A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth. Journal of the American Medical Informatics Association: JAMIA 2013; 20 (Suppl. 04) 758-765. PubMed PMID: 23512830.
  • 29 Adams A, Blandford A, Attfield S. Implementing digital resources for clinicians’ and patients’ varying needs. Medical informatics and the Internet in medicine 2005; 30 (Suppl. 02) 107-122. PubMed PMID: 16338799.
  • 30 Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: the importance of special people. International journal of medical informatics 2003; 69 2–3 235-250. PubMed PMID: 12810127.
  • 31 Lyons SS, Tripp-Reimer T, Sorofman BA, Dewitt JE, Bootsmiller BJ, Vaughn TE, Doebbeling BN. VA QUERI informatics paper: information technology for clinical guideline implementation: perceptions of multidisciplinary stakeholders. Journal of the American Medical Informatics Association: JAMIA 2005; 12 (Suppl. 01) 64-71. PubMed PMID: 15492035. Pubmed Central PMCID: 543828.
  • 32 Childs S. Developing health website quality assessment guidelines for the voluntary sector: outcomes from the Judge Project. Health information and libraries journal 2004; 21 (Suppl. 02) 14-26. PubMed PMID: 15317572.
  • 33 Darbyshire P. ’Rage against the machine?’: nurses’ and midwives’ experiences of using Computerized Patient Information Systems for clinical information. Journal of clinical nursing 2004; 13 (Suppl. 01) 17-25. PubMed PMID: 14687289.

Correspondence to:

Tiffani J. Bright PhD
Columbia University
Department of Biomedical Informatics
622 West 168th St. VC5
New York, NY 10032

  • References

  • 1 Duarte J, Guerra A. User-Centered Healthcare Design. Procedia Computer Science 2012; 14 (Suppl. 00) 189-197.
  • 2 Horsky J, Schiff GD, Johnston D, Mercincavage L, Bell D, Middleton B. Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions. Journal of biomedical informatics 2012; 45 (Suppl. 06) 1202-1216. PubMed PMID: 22995208.
  • 3 Nowlan WA. Clinical workstations: identifying clinical requirements and understanding clinical information. International journal of bio-medical computing 1994; 34 (1-4) 85-94 PubMed PMID: 8125657.
  • 4 Teixeira L, Ferreira C, Santos BS. User-centered requirements engineering in health information systems: a study in the hemophilia field. Computer methods and programs in biomedicine 2012; 106 (Suppl. 03) 160-174. PubMed PMID: 21075471.
  • 5 Borycki EM, Househ M, Kushniruk AW, Kuziemsky C. Use of qualitative methods across the software development lifecycle in health informatics. Studies in health technology and informatics 2011; 164: 293-297. PubMed PMID: 21335726.
  • 6 Kushniruk A. Evaluation in the design of health information systems: application of approaches emerging from usability engineering. Computers in biology and medicine 2002; 32 (Suppl. 03) 141-149. PubMed PMID: 11922931.
  • 7 Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, Samsa G, Hasselblad V, Williams JW, Musty MD, Wing L, Kendrick AS, Sanders GD, Lobach D. Effect of clinical decision-support systems: a systematic review. Annals of internal medicine 2012; 157 (Suppl. 01) 29-43. PubMed PMID: 22751758.
  • 8 Currie LM, Mellino LV, Cimino JJ, Li J, Bakken S. Requirements specification for automated fall and injury risk assessment. Studies in health technology and informatics 2006; 122: 134-138. PubMed PMID: 17102234.
  • 9 Greenes RA, Collen M, Shannon RH. Functional requirements as an integral part of the design and development process: summary and recommendations. International journal of bio-medical computing 1994; 34 1–4 59-76. PubMed PMID: 8125655.
  • 10 Colgan R, Powers JH. Appropriate antimicrobial prescribing: approaches that limit antibiotic resistance. American family physician 2001; 64 (Suppl. 06) 999-1004. PubMed PMID: 11578036.
  • 11 Fishman N. Antimicrobial stewardship. American journal of infection control 2006; 34 (5 Suppl 1) S55-S63 discussion S4–S73. PubMed PMID: 16813983.
  • 12 Pestotnik SL. Expert clinical decision support systems to enhance antimicrobial stewardship programs: insights from the society of infectious diseases pharmacists. Pharmacotherapy 2005; 25 (Suppl. 08) 1116-1125. PubMed PMID: 16207103.
  • 13 Filice GA, Drekonja DM, Thurn JR, Rector TS, Hamann GM, Masoud BT, Leuck AM, Nordgaard CL, Eilertson MK, Johnson JR. Use of a computer decision support system and antimicrobial therapy appropriateness. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America 2013; 34 (Suppl. 06) 558-565. PubMed PMID: 23651885.
  • 14 Leibovici L, Kariv G, Paul M. Long-term survival in patients included in a randomized controlled trial of TREAT, a decision support system for antibiotic treatment. The Journal of antimicrobial chemotherapy 2013 Jun 5. PubMed PMID: 23743088.
  • 15 Litvin CB, Ornstein SM, Wessell AM, Nemeth LS, Nietert PJ. Use of an Electronic Health Record Clinical Decision Support Tool to Improve Antibiotic Prescribing for Acute Respiratory Infections: The ABX-TRIP Study. Journal of general internal medicine 2013; 28 (Suppl. 06) 810-816. PubMed PMID: 23117955. Pubmed Central PMCID: 3663943.
  • 16 Mainous AG, 3rd Lambourne CA, Nietert PJ. Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial. Journal of the American Medical Informatics Association: JAMIA 2013; 20 (Suppl. 02) 317-324. PubMed PMID: 22759620. Pubmed Central PMCID: 3638170.
  • 17 Krueger R. Focus groups: a practical guide for applied research. Newbury Park (CA): Sage Publications; 1988
  • 18 Elo S, Kyngas H. The qualitative content analysis process. Journal of advanced nursing 2008; 62 (Suppl. 01) 107-115. PubMed PMID: 18352969.
  • 19 Thomas DR. A general inductive approach for analyzing qualitative evaluation data. American journal of evaluation 2006; 27 (Suppl. 02) 237-246.
  • 20 Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology 2006; 3 (Suppl. 02) 77-101.
  • 21 Guba EG, Lincoln YS. Epistemological and methodological bases of naturalistic inquiry. ECTJ 1982; 30 (Suppl. 04) 233-252.
  • 22 Rodgers BL, Cowles KV. The qualitative research audit trail: A complex collection of documentation. Research in Nursing & Health 1993; 16 (Suppl. 03) 219-226.
  • 23 Schnall R, Gordon P, Camhi E, Bakken S. Perceptions of factors influencing use of an electronic record for case management of persons living with HIV. AIDS care 2011; 23 (Suppl. 03) 357-365. PubMed PMID: 21347899. Pubmed Central PMCID: 3129034.
  • 24 Wolf ZR. Exploring the audit trail for qualitative investigations. Nurse educator 2003; 28 (Suppl. 04) 175-178. PubMed PMID: 12878896.
  • 25 Chused A. Development of a taxonomy to aid management of computerized alerts. Unpublished manuscript, Department of Biomedical Informatics, Columbia University, New York, NY 2009.
  • 26 Bright TJ, Yoko Furuya E, Kuperman GJ, Cimino JJ, Bakken S. Development and evaluation of an ontology for guiding appropriate antibiotic prescribing. Journal of biomedical informatics 2012; 45 (Suppl. 01) 120-128. PubMed PMID: 22019377. Pubmed Central PMCID: 3272092.
  • 27 Jenkings KN, Wilson RG. The challenge of electronic health records (EHRs) design and implementation: responses of health workers to drawing a ‘big and rich picture’ of a future EHR programme using animated tools. Informatics in primary care 2007; 15 (Suppl. 02) 93-101. PubMed PMID: 17877871.
  • 28 Veinot TC, Campbell TR, Kruger DJ, Grodzinski A. A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth. Journal of the American Medical Informatics Association: JAMIA 2013; 20 (Suppl. 04) 758-765. PubMed PMID: 23512830.
  • 29 Adams A, Blandford A, Attfield S. Implementing digital resources for clinicians’ and patients’ varying needs. Medical informatics and the Internet in medicine 2005; 30 (Suppl. 02) 107-122. PubMed PMID: 16338799.
  • 30 Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: the importance of special people. International journal of medical informatics 2003; 69 2–3 235-250. PubMed PMID: 12810127.
  • 31 Lyons SS, Tripp-Reimer T, Sorofman BA, Dewitt JE, Bootsmiller BJ, Vaughn TE, Doebbeling BN. VA QUERI informatics paper: information technology for clinical guideline implementation: perceptions of multidisciplinary stakeholders. Journal of the American Medical Informatics Association: JAMIA 2005; 12 (Suppl. 01) 64-71. PubMed PMID: 15492035. Pubmed Central PMCID: 543828.
  • 32 Childs S. Developing health website quality assessment guidelines for the voluntary sector: outcomes from the Judge Project. Health information and libraries journal 2004; 21 (Suppl. 02) 14-26. PubMed PMID: 15317572.
  • 33 Darbyshire P. ’Rage against the machine?’: nurses’ and midwives’ experiences of using Computerized Patient Information Systems for clinical information. Journal of clinical nursing 2004; 13 (Suppl. 01) 17-25. PubMed PMID: 14687289.