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Article Title

Evaluation of Provider Experience With an Electronic Health Record-Based Clinical Decision Support Tool

Publication Date

4-30-2015

Keywords

clinical decision support, cardiovascular risk

Abstract

Background/Aims: Our goal was to evaluate provider experience with an electronic health record (EHR)-based clinical decision support (CDS) tool called CV Wizard implemented as part of a large randomized trial with 80% use rates for eligible patients. The tool included a quantitative “provider” form with prioritized treatment suggestions and a simpler visual companion “patient” form to efficiently elicit treatment preferences.

Methods: Two focus groups were held outside of clinic hours with a meal and $250 compensation. Twelve providers participated and were asked to comment on open-ended questions including a) what goes into their decision to use the tool, b) the implementation process, c) how patients reacted to it, d) how it could be improved, and e) how effective it was. The discussions were audio-taped and transcribed verbatim and examined by the study team to identify themes.

Results: Providers were enthusiastic about the tool and found it valuable. They were happy that the nurse printed it for them before visits, and commented that it helped set the visit agenda and organized cardiovascular (CV) risk information. They were more likely to discuss CV risk with patients, and indicated that they took additional time to use it with patients. There was general consensus that it was time well spent. They said the tool reinforced their treatment suggestions. Variability was noted with how nurses and providers were using the tools. For conversations with patients, some providers preferred to use the provider form over the patient form, and vice versa. The patient form was intended to be given to the patient while waiting to be seen by the provider, but this was often not happening. Providers had several suggestions for improving the use process, and asked for better documentation tools for results (smart phrases).

Discussion: A clinical decision support tool designed to help providers and patients engage in shared decision-making for CV risk reduction was well received and perceived as time well spent with patients. Overcoming some problems associated with workflow and adding easier ways to document use of the tool for patient discussions would add to the existing value.

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