Background

Clinical Decision Support Systems (CDSS) can make patient care more efficient, cost-effective, and guideline-concordant. Many are created by clinicians who understand the challenges, but may publish concepts before considering subtle but important design details. Human-Centred Design (HCD) approaches provide necessary methods ensuring solid CDSS design. This article highlights HCD approaches in a pulmonary embolism CDSS case study context.

Methods

This pulmonary embolism CDSS results from collaborative work between computer science, psychology, and medicine. HCD methods used include: evaluations of pre-clinical prototype recordings, iterative usability expert reviews with software refinement, formative usability testing, and (separately-published) clinical pilot study.

Results

HCD methods were instrumental in iteratively creating an easy to use and functionally-sound CDSS. Retrospective evaluations revealed that participants spent considerable time on items that were out of order from natural cognitive diagnostic workflows. Features missing between original and study version were noted, confusing interface elements reworked, and currently-active decision tree branches were visually emphasized. From iterative usability reviews, positioning of information within the decision tree was radically reworked, information separated into levels of support for different user groups, and supportive versus directive language issues addressed. Formative studies identified issues such as interface adjustments and hospital workflow integration.

Conclusions

Human-centred design approaches provide methods for integrating the skills and knowledge of many disciplines, illustrated by example in this pulmonary embolism CDSS creation. Advantages of leveraging many design guidelines as well as revealing new design considerations that would otherwise have remained hidden are described. The findings reported here support future CDSS design through HCD inclusion.

中文翻译：

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以人为本的临床决策支持设计流程：一项肺栓塞案例研究。

背景

临床决策支持系统（CDSS）可以使患者护理更加有效，具有成本效益并且符合指南要求。许多是由了解挑战的临床医生创建的，但是可能在考虑细微但重要的设计细节之前先发布概念。以人为本的设计（HCD）方法提供了确保可靠的CDSS设计的必要方法。本文重点介绍了肺栓塞CDSS案例研究中的HCD方法。

方法

这种肺栓塞CDSS来自计算机科学，心理学和医学之间的合作。使用的HCD方法包括：临床前原型记录的评估，软件改进的迭代可用性专家评审，形成性可用性测试以及（单独出版的）临床试验研究。

结果

HCD方法有助于迭代创建易于使用且功能完善的CDSS。回顾性评估显示，参与者花费了大量时间处理自然认知诊断工作流程中不合规定的项目。指出了原始版本和研究版本之间缺少的功能，重新设计了令人困惑的界面元素，并在视觉上强调了当前活动的决策树分支。从迭代的可用性审查中，信息树在决策树中的位置得到了彻底的重新设计，将信息分为对不同用户组的支持级别，并解决了支持性语言与指令性语言问题。形成性研究确定了诸如界面调整和医院工作流程集成之类的问题。

结论

以人为中心的设计方法提供了整合许多学科的技能和知识的方法，例如在肺栓塞CDSS的创建过程中举例说明。描述了利用许多设计准则以及揭示本来会隐藏的新设计注意事项的优点。此处报告的发现通过纳入HCD支持了未来CDSS设计。