Designing User-Centered Decision Support Tools for Chronic Pain in Primary Care

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By characterizing common patterns in information availability, information use, and care planning by primary care providers during patient visits for chronic pain, researchers created new electronic health record-based decision support tools to guide clinicians’ perceptions and judgments of noncancer pain to increase use of guideline-based patient assessment and treatment.

Project Details -
Completed

While millions of Americans suffer from chronic pain, negatively impacting healthcare costs and lost worker productivity, most providers receive little training in pain care. The use of decision support tools, such as computerized alerts or checklists within electronic health records (EHRs), has the potential to improve pain care. However, to be effective, decision support must be designed based on a detailed understanding of how clinicians use information to understand patients’ conditions (i.e., clinical sensemaking). Therefore, research is needed to characterize clinical work environments, information needs and use, and decisionmaking. Such research is especially relevant to chronic noncancer pain in primary care, where clinicians often report dissatisfaction and uncertainty when managing patients.

The overall goal of this project was to develop decision support tools that integrate with EHRs to increase the quality and effectiveness of chronic pain care.

The specific aims of the project are as follows:

  • Characterize primary care clinicians’ information use and decisionmaking patterns during patient visits for musculoskeletal pain to determine how they align with clinical practice guidelines 
  • Prototype and preliminarily evaluate new decision support designs to meet clinicians’ information needs and guide them toward guideline-based information use and care choices 

For the first aim, data were collected from medical records, visit audio recordings, and post-visit clinician interviews. These data were analyzed to cluster visits into similar sensemaking narratives and used to identify common missed opportunities in which decision support could have altered the use of clinical information or altered care plan choices to better align with guideline recommendations. The project team conducted a design workshop and usability testing to produce prototypes for guideline-based decision support systems that was integrated in EHRs.

This study demonstrated the value of a user-centered approach to designing clinical decision support systems for clinicians caring for patients with chronic pain. The user-centered design approach puts the human user first when creating new computer applications and the researchers analyzed how clinicians used patient information in their work to choose the safest and most effective medications and other treatments for pain.

Four design approaches were found to be key for EHR and clinical decision support developers to help clinicians be more efficient and guideline-concordant during chronic pain care: (1) making key information accessible in a single view, (2) organizing information in tables, (3) allowing users to interactively move between summary and detailed information, and (4) providing visual cues to help focus users’ attention. These four design approaches were used to create two prototype clinical decision support systems: Chronic Pain OneSheet and Chronic Pain Treatment Tracker.

User-Centered Decision Support Tools for Chronic Pain

User-Centered Decision Support Tools for Chronic Pain

By characterizing common patterns in information availability, information use, and care planning by primary care providers during patient visits for chronic pain, researchers created new electronic health record-based decision support tools to guide clinicians’ perceptions and judgments of pain to increase use of guideline-based patient assessment and treatment.

Principal Investigator: Harle, Christopher Albert
Organization: Indiana University-Purdue University at Indianapolis
Research Profile: Designing User-Centered Decision Support Tools for Chronic Pain in Primary Care
Funded Amount: $1,954,230

Caring for and treating complex chronic conditions

Taking care of patients who have complex chronic conditions is best facilitated when a clinician has access to their entire clinical history. A holistic approach is important to understand the best treatment plan for the patient, whether it involves prescribing opioids or other options, based on previous medical history. Electronic health records (EHRs) often have less-than-ideal navigation to access relevant patient data, and finding these data may be challenging as a clinician gets up to speed during a brief clinic visit. Because opioid misuse is a public health crisis, clinicians are eager for guidance to navigate appropriate treatment options for patients with chronic conditions dealing with pain. With a public health policy and information science background, Dr. Christopher Harle was interested in how to use computers and technology to help clinicians take care of patients with complex, and often painful, conditions.

What we designed is meant to bring information together in a single place for a primary care clinician to get a holistic picture of their patients and ultimately lead them to choose the right treatment plan.”
- Dr. Harle

Centralized data for easy access

Using qualitative methods, such as interviewing clinicians and reviewing patient medical records, Dr. Harle and the research team at Indiana University and The Regenstrief Institute in Indianapolis wanted to understand how patient information could be best displayed in EHRs to support clinicians in providing the best treatment options for these complex patients. Ultimately, this work led to designing a simplified EHR interface that focused on bringing patient information together in an accessible way for clinicians. Two user-centered prototype decision support tools were created. The first tool—the Chronic Pain OneSheet—was designed to provide accessible data in an EHR for gathering key clinical information. The second tool—the Chronic Pain Treatment Tracker—is used to track treatment and outcomes for patients with chronic pain.

User-centered design

Dr. Harle and his team found that user-centered design research was foundational in the development of usable and useful EHR interfaces, such as Chronic Pain OneSheet and Chronic Pain Treatment Tracker. The design of the prototypes captured the distinctive nature of patterns in accessing patient data by characterizing common patterns in information availability, information use, and care planning. These designs help clinicians overcome barriers of technologies that are not user friendly for treatment of chronic pain. The user-centered decision support tools allow clinicians to have an overall picture of patients in an easy and accessible way to help treat a patient with chronic pain.