Evaluation of the Acceptability and Usability of a Decision Support System to Encourage Safe and Effective Use of Opioid Therapy for Chronic, Noncancer Pain by Primary Care Providers

Authors

  • Jodie Trafton PhD,

    Corresponding author
    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
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  • Susana Martins MD, MSc,

    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
    2. Geriatrics Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto
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  • Martha Michel PhD,

    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
    2. Geriatrics Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto
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  • Eleanor Lewis PhD,

    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
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  • Dan Wang PhD,

    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
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  • Ann Combs BA,

    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
    2. Palo Alto Institute for Research and Education, Palo Alto
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  • Naquell Scates MHA,

    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
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  • Samson Tu MS,

    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
    2. Center for Biomedical Informatics Research, Stanford University Medical School, Stanford
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  • Mary K. Goldstein MD, MS

    1. Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park
    2. Geriatrics Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto
    3. Center for Biomedical Informatics Research, Stanford University Medical School, Stanford
    4. Center for Primary Care and Outcomes Research (PCOR), Stanford University, Stanford, California, USA
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  • Conflicts of Interest: Authors declare no conflicts of interest.

Jodie Trafton, PhD, Center for Health Care Evaluation, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Tel: 650-493-5000 x22474; Fax: 650-617-2736; E-mail: Jodie.Trafton@va.gov.

Abstract

Objective.  To develop and evaluate a clinical decision support system (CDSS) named Assessment and Treatment in Healthcare: Evidenced-Based Automation (ATHENA)-Opioid Therapy, which encourages safe and effective use of opioid therapy for chronic, noncancer pain.

Design.  CDSS development and iterative evaluation using the analysis, design, development, implementation, and evaluation process including simulation-based and in-clinic assessments of usability for providers followed by targeted system revisions.

Results.  Volunteers provided detailed feedback to guide improvements in the graphical user interface, and content and design changes to increase clinical usefulness, understandability, clinical workflow fit, and ease of completing guideline recommended practices. Revisions based on feedback increased CDSS usability ratings over time. Practice concerns outside the scope of the CDSS were also identified.

Conclusions.  Usability testing optimized the CDSS to better address barriers such as lack of provider education, confusion in dosing calculations and titration schedules, access to relevant patient information, provider discontinuity, documentation, and access to validated assessment tools. It also highlighted barriers to good clinical practice that are difficult to address with CDSS technology in its current conceptualization. For example, clinicians indicated that constraints on time and competing priorities in primary care, discomfort in patient-provider communications, and lack of evidence to guide opioid prescribing decisions impeded their ability to provide effective, guideline-adherent pain management. Iterative testing was essential for designing a highly usable and acceptable CDSS; however, identified barriers may limit the impact of the ATHENA-Opioid Therapy system and other CDSS on clinical practices and outcomes unless CDSS are paired with parallel initiatives to address these issues.

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