Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

Details

• Personal Author:
  Ash JS ; Baron, Sherry L. ; Chase D ; Filios, Margaret S. ; Luensman GB ; Marovich S ; Shiffman RN ; Wiesen J
• Description:
  Background: Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective: This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods: We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results: We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion: We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health. [Description provided by NIOSH]
• Subjects:
  Decision Making Diagnosis Occupational Health Safety
• Keywords:
  Author Keywords: Attitude To Computers Clinical Decision Support Clinical Diagnosis Decision Making Electronic Health Records Hospital Information Systems Intervention Effectiveness Occupational Health Occupations Physician Order Entry Qualitative Analysis Recordkeeping Surveillance

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• ISSN:
  1869-0327
• Document Type:
  Text
• Funding:
  Contract
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; New York ; Oregon ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 2 ; OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  11
• Issue:
  4
• NIOSHTIC Number:
  nn:20061095
• Citation:
  Appl Clin Inform 2020 Aug; 11(4):635-643
• Contact Point Address:
  Joan S. Ash, PhD, Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
• Email:
  ash@ohsu.edu
• Federal Fiscal Year:
  2020
• Peer Reviewed:
  True
• Source Full Name:
  Applied Clinical Informatics
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:effee560363041a152b7a7ed902d1cf8eed821bc5b627a8d3c59d597869f5ea0fe93228df5623db0f72de6d725e6c94f5a5f1e26c6165b17759d0b2661d2ce22
• Download URL:
  https://stacks.cdc.gov/view/cdc/224764/cdc_224764_DS1.pdf
• File Type:
  [PDF - 398.94 KB ]