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Clinical Informatics

Evaluating a Clinical Decision Support System: A basic field study approach

Index:

  1. Introduction

  2. Evaluation framework and techniques

  3. Evaluation processes

    1. Basic usability

    2. Field study results

  4. Redesign possibilities

  5. Strengths and weaknesses of the field study approach

  6. Conclusion

  7. References

Basic Usability

Effectiveness, Efficiency and Utility:

Effectiveness is measured by whether the system does what it is designed to do. Efficiency is measured by how much the system support the users in their everyday tasks and utility refers to whether the system provides the functionality for the users to do what they want or need to do.

Reduction of Perscribing Errors

The main aim of the system is to reduce prescribing errors and it does this well via the robust rules-based decision support system which is integrated and is constantly monitored and improved upon by the pharmacy team.

Feedbacks from the junior doctors indicate that this feature works well. Nursing staff also have very positive feedback as they no longer have to deal with illegible orders and can have more confidence in their dispensing duties.

If there is a high level of error detected with a particular drug, the pharmacist can then educate the staff or address the underlying issues that may have led to the inappropriate prescribing practises.

Patient Administration and Discharge Summaries

The system also facilitates the tracking, transfer and discharge of patients, which is another big part of the workflow patter of nurses and junior doctors. It has a built-in facility to formulate a discharge summary which also includes all their current medications on the ward. This information is also required by pharmacy in order to prepare the take-home orders.

The discharge summary tool allows the import of all relevant information and avoids repetition of data entry. This also removes the possibility of error occurring during transcribing of information from one section to the other. Again, legibility is improved tremendously as the summary is then printed out. A copy is then sent electronically to the pharmacy for their action.

This allows a much more co-ordinated and efficient discharge process for the patient and reduces non-essential repetitive work for all involved. Again, feedbacks have been very positive from all sides.

Messaging and Test Requesting

The messaging module has also proven to be useful, facilitating the communication between the three main users and allowing the nursing and pharmacy staff to make proposals as regards patient care to the medical team. This have led to more helpful suggestions as the nursing and pharmacy staff no longer feel like they have to  “interrupt” the busy junior staff to do so.

Last but not least, the ability to request tests and access results on-line have dramatically reduced the amount of paper-work for the junior medical staff and resulted in more timely interventions when abnormal results are found and "flagged-up" by the system.

Hence, the CDSS seems to meet the three criteria of effectiveness, efficiency and utility

Safety

Access is protected by username and passwords. This will also determine the types of features accessible to the individual user. Built-in restraints will grey out the features not available to the user.

The rules based system is very robust and will not allow the prescription of any drugs with an absolute contraindication, inaccurate dosing, inaccurate frequency or route of admission in any patient.

Patient data is constantly backed up on a second server in real time and there is also a local backup server in case of emergency. The staff would also be able to print out all the drug charts locally should there be a complete failure of the networking system for whatever reason.

This has improved the confidence of the users in the system.

Learnability and Memorability

As the CDSS is a complex and multi-function system, it does not and is not expected to meet the “ten-minute rule”.(5) Non-clinical users are given a 40 minute training session while clinical users are given 90 minute sessions. This is based on the assumption of the individual having basic computing skills only. Further sessions can be arranged and a systems’ tutor is always available during the roll-out period to give hands on assistance.

Although the nursing staff anticipated difficulties in using the system, they were pleasantly surprised to find that they were able to operate the system effectively after one or two training sessions. This applied throughout the wide range of user experience with computing as well as across the age groups.

Due to its high visibility of the common tasks and logical sequencing of tasks, memorability of the system was high. Users did not report any significant difficulties in remembering how to use the system once learnt.

 

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Page Updated: 17 May, 2017

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