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Translating clinicians’ needs into requirements for a future Computerised Decision Support System in antibiotic therapy : a user-centred design and requirements engineering approach in a German geriatric hospital setting
| Content Provider | Semantic Scholar |
|---|---|
| Author | Muench, Dawn F. |
| Copyright Year | 2016 |
| Abstract | Background Inappropriate decision making is the most common reason for inadequate antibiotic therapy in hospital settings, with the highest amount of errors occurring in antibiotic prescribing. Hospitals are complex workplaces and information-intensive environments, dealing with complex patient cases and high prevalence, urgent, complex and cognitively demanding tasks. In an effort to increase the quality of antibiotic prescribing, Computerised Decision Support Systems (CDSSs) have been promoted as a tool for improving effectiveness and efficiency of clinical decisions and facilitating optimal clinical decisions in hospitals. However, numerous CDSSs lack reception, acceptance, and utilisation of their users being ascribed to inadequately satisfying the need of end-users, insufficient effort to establish user requirements, and lack of user involvement in the design process. Therefore, the purpose of this study was to identify user needs and to translate these needs into requirements for a future CDSS with user-centred design (UCD) and requirements engineering (RE) to optimally support and assist clinicians in antibiotic therapy. Method A UCD and RE approach with contextual inquiry and value specification was applied. Throughout requirements elicitation, exploratory qualitative study methods (direct clinical field observations and scenario-based face-to-face semi-structured interviews) were applied to elicit li i ia s eeds a d the necessary input and requirements for a future CDSS in a German geriatric, public, not-for-profit, academic teaching hospital, comprising 171 licensed beds in six specialty departments. Six junior doctors were observed during clinical morning geriatric ward rounds and eleven internal medicine clinicians (consultants and junior doctors) participated in the interviews. Exclusion criteria were surgeons and paediatricians. Data from elicitation activities were transcribed verbatim and analysed with thematic analysis and communicated in a requirements notation table adding the rationale, type and source of a specific requirement. Results Sixteen end-user requirements that need to be supported by and integrated within a future CDSS in antibiotic therapy were identified: (1) step-wise advice (e.g., in the form of a flowsheet or clinical pathway) in the selection of antibiotic agents, diagnostic, laboratory and microbiological tests under consideration of patient-specific characteristics, clinical suspicion of the infection and the (likely) pathogen, (2) a dose calculator in patients with organ failure, (3) advice in complex non-routine care, (4) registration of internal surveillance data, (5) general infectious-disease recommendations on markers for bacterial infection, (6) real-time reminders in the selection of antibiotics and monitoring of antibiotic therapy, (7) real-time alerts in the selection and ordering of antibiotics, (8) interface of aggregated patient-specific data for image and results delivery, (9) automatization of advice within clinical workflow and reduced need for manual data entry, (10) uniformity and compatibility of IT systems, (11) connection and interoperability of different local and external IT systems and exchangeability of patient data with different hospitals, (12) high quality advice based on recent evidence-based guidelines, (13) reduction of log-inand loading times, (14) desktop version on the computer, (15) installation of the system on local servers, and (16) access rights and medical data protection of electronic patient information. Conclusion UCD incorporating contextual inquiry and value specification methodology applying RE techniques were ideally suited to describe and identify the complex clinical work environment of clinicians, their tasks and practices and the process of decision care, information needs and sources and barriers. More importantly, these techniques played an important role in formulating user e ui e e ts a d p o ided li i ia s ie s of possi le oppo tu ities a d isks ithi the ea l development of a future CDS tool in antibiotic therapy. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://essay.utwente.nl/70678/1/M%C3%BCnch_MA_BMS.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
