HF design process | Design activities and outcomes |
1. HF analysis of PE diagnosis in the ED | Identification of multiple work system barriers and facilitators to cognitive work involved in PE diagnosis; in particular technology-related barriers for information gathering activities in PE diagnostic process |
2. Analysis of suggestions made by ED physicians regarding health IT solutions | Main suggestions for CDS to support PE diagnosis in ED included:
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3. Nine interdisciplinary design sessions over 1 year for a total of 13.5 hours (each session was between 1 and 2 hours) | Decision by design team to focus the CDS on how to support diagnostic pathway for PE diagnosis. Multiple disciplines involved in design sessions: HF, emergency medicine and software engineering/programming. Use of iterative design process with multiple mock-ups of PE-Dx CDS (created in PowerPoint) |
4.Two 1-hour focus groups with four ED physicians (interspersed between design sessions) for review of PE-Dx CDS mock-up | Confirmation of preference for two-step CDS: presentation of Wells’ and then PERC; match with hospital policy. Use of highest heart rate/pulse value and lowest O2 saturation value; but need to allow physicians to update these values |
5.Creation of PE-Dx CDS in EHR Playground | Programming of PE-Dx CDS in EHR Playground based on PowerPoint mock-up |
6.Two-hour participatory heuristic evaluation of PE-Dx CDS with seven participants (HF engineers, physicians, systems analyst) | Identification of 19 usability problems; 13 problems resolved through design changes to PE-Dx CDS; six problems not addressed because of constraints of flowsheet functionality of local EHR Production of final PE-Dx CDS tested in usability evaluation |
ED, emergency department; IT, information technology; PE-Dx CDS, clinical decision support for pulmonary embolism diagnosis.