Susana Martins

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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

Pain Medicine, 2010

Objective. To develop and evaluate a clinical decision support system (CDSS) named Assessment and... more 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 simulationbased 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 patientprovider 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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Improving Patient Safety Using ATHENA-Decision Support System Technology: The Opioid Therapy for Chronic Pain Experience

The purpose of this paper is to describe potential improvements in patient safety resulting from ... more The purpose of this paper is to describe potential improvements in patient safety resulting from design decisions in the development of a computerized decision support system (DSS) for managing opioid therapy for chronic noncancer pain. ATHENA-DSS is an automated decision support system developed in a collaboration between Stanford University and the U.S. Department of Veterans Affairs (VA) to increase guideline-adherent prescribing and to change physician behavior. Based on data in patients' computerized medical record and knowledge of the clinical domain encoded in a knowledge base, the system gives patient-specific recommendations to primary care providers at the point of care. ATHENA-Opioid Therapy is based on a previous system, ATHENA-Hypertension, and is designed to follow the VA/Department of Defense clinical practice guideline for the management of opioid therapy for chronic noncancer pain. We describe the rationale for development of decision support system elements and a graphical user interface to increase patient safety during primary care treatment for chronic pain. The ATHENA-Opioid Therapy system focuses on reducing patient risk in four main ways by: (1) identifying patients with comorbidities or concurrent prescriptions that raise risk for overdose and recommending more conservative dosing; (2) identifying patients with mental health problems that increase risk of medication abuse and recommending referral to psychiatric care and close monitoring; (3) assisting doctors with complex pharmacologic calculations to reduce the risk of mistakes when initiating, titrating, or switching medications; and (4) presenting relevant information to clinicians in an easy-to-use format. We describe a system evaluation plan that we believe is essential to ensure that deployment of ATHENA-Opioid Therapy leads to improvements in patient safety and increases in guideline-concordant prescribing, and we discuss the limitations of this system for patient safety efforts.

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Renal dysfunction in acute coronary syndrome--an epidemic for the 21st century?

Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2010

Susana Martins

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