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. 2024 Nov 1;31(11):2641-2650.
doi: 10.1093/jamia/ocae247.

Exploring home healthcare clinicians' needs for using clinical decision support systems for early risk warning

Zidu Xu  1 , Lauren Evans  2 , Jiyoun Song  3 , Sena Chae  4 , Anahita Davoudi  2 , Kathryn H Bowles  2   3 , Margaret V McDonald  2 , Maxim Topaz  1   2
Affiliations

Exploring home healthcare clinicians' needs for using clinical decision support systems for early risk warning

Zidu Xu et al. J Am Med Inform Assoc. .

Abstract

Objectives: To explore home healthcare (HHC) clinicians' needs for Clinical Decision Support Systems (CDSS) information delivery for early risk warning within HHC workflows.

Methods: Guided by the CDS "Five-Rights" framework, we conducted semi-structured interviews with multidisciplinary HHC clinicians from April 2023 to August 2023. We used deductive and inductive content analysis to investigate informants' responses regarding CDSS information delivery.

Results: Interviews with thirteen HHC clinicians yielded 16 codes mapping to the CDS "Five-Rights" framework (right information, right person, right format, right channel, right time) and 11 codes for unintended consequences and training needs. Clinicians favored risk levels displayed in color-coded horizontal bars, concrete risk indicators in bullet points, and actionable instructions in the existing EHR system. They preferred non-intrusive risk alerts requiring mandatory confirmation. Clinicians anticipated risk information updates aligned with patient's condition severity and their visit pace. Additionally, they requested training to understand the CDSS's underlying logic, and raised concerns about information accuracy and data privacy.

Discussion: While recognizing CDSS's value in enhancing early risk warning, clinicians highlighted concerns about increased workload, alert fatigue, and CDSS misuse. The top risk factors identified by machine learning algorithms, especially text features, can be ambiguous due to a lack of context. Future research should ensure that CDSS outputs align with clinical evidence and are explainable.

Conclusion: This study identified HHC clinicians' expectations, preferences, adaptations, and unintended uses of CDSS for early risk warning. Our findings endorse operationalizing the CDS "Five-Rights" framework to optimize CDSS information delivery and integration into HHC workflows.

Keywords: decision support systems; home healthcare; nursing informatics; user-friendly interface; workflow integration.

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Conflict of interest statement

None declared.

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