Towards Usable openEHR-aware Clinical Decision Support: A User-centered Design Approach

Licentiate thesis, 2011

Nowadays, the use of computerized approaches to support health care processes in order to improve quality of health care is widespread in the clinical domain. Electronic health records (EHR) and clinical decision support (CDS) are considered to be two complementary approaches to improve quality of health care. It is shown that EHRs are not able to improve quality of health care without being supported by other features such as CDS. On the other hand, one of the success factors of CDS is its integration into EHR, and since there are various international EHR standards (such as openEHR) being developed, it is crucial to take these standards into consideration while developing CDS. Various clinical decision support systems (CDSS) are developed but unfortunately only a few of them are being used routinely. Two of the reasons for unacceptability of CDSSs among their users, i.e. clinicians, are shown to be their separation from EHRs and poor usability of the user interfaces. Besides integration into underlying information framework, i.e. EHR systems, consideration of human-computer interaction (HCI) in designing and evaluating CDS is one of the success factors that developers of these systems should keep in mind. This thesis addresses the question of how usable openEHR-aware clinical decision support can be designed and developed in order to improve the quality of health care. To answer this research question, several sub-questions were identified and investigated. This included analyzing \state of the art" in two different aspects of design and development and evaluation of CDS and also investigating application of a customized user-centered design (UCD) process in developing openEHR-based clinical applications. Analysis of state of the art in interplay between HCI and CDS and also the intersection between CDS and EHR revealed that consideration of both HCI and integration of CDS into EHR is more appreciated in theory than in practice and there is still a long way to go before reaching an acceptable level in these two success factors of CDS. Moreover, the experience in designing an openEHR-based clinical application revealed that apart from benefits offered by openEHR approach, such as specifying different roles and involvement of domain experts in defining domain concepts, there are various shortcomings that need to be improved, for instance the limited support for openEHR application developers. Additionally, this study revealed that there are characteristics of the domain, tasks and users in the domain that developers should be informed about while applying UCD methods.