The Experiences of Using a Computerized Decision Support System Mariann Fossum, RN, MSc1,2, Margareta Ehnfors, RNT, PhD1, Ann Fruhling, PhD3, Anna Ehrenberg, RN, PhD 4 1
School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Centre for Caring Research – Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 3 School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska, Omaha, USA; 4 School of Health and Social Studies, Dalarna University, Falun, Sweden 2
Abstract The aim was to describe the facilitators and barriers influencing the ability of nursing personnel to effectively use a CDSS for planning and treating pressure ulcers and malnutrition in nursing homes. Usability evaluations and group interviews were conducted. Facilitators were ease of use, usefulness and a supportive work environment. Lack of training, resistance to using computers and limited integration of the CDSS with the electronic health record system were reported. Introduction A number of advanced clinical computerized decision support systems (CDSSs) have failed to support nursing personnel in their daily work1. Assessment of what kind of factors may promote or hamper the use, will give valuable knowledge to increase the quality of the CDSSs used by nursing personnel in nursing homes. Systematic usability evaluations conducted in natural settings can provide important knowledge about how to support the nursing personnels’ decision making by technology. Methods This qualitative descriptive study with two usability evaluations and four group interviews was conducted in 2009- 2010 after an intervention study2. The cognitive walkthrough observations had five participants recruited as experts and was conducted in a nursing home. After the observation the participants answered a usability evaluation questionnaire. Three scenarios were used for the cognitive walkthrough observation. A semistructured interview guide was used for the group interviews conducted in four nursing homes where the CDSS had been implemented. Text was analyzed using qualitative content analysis and the quantitative data from the questionnaire was analyzed using statistics in Excel. Results Participants reported that more emphasis was placed on preventing, treating and documenting pressure ulcers and malnutrition after the implementation of the CDSS. CDSS design facilitators were: ease of use, usefulness and a supportive work environment. Lack of training, resistance to using computers and limited integration of the CDSS with the electronic health record system were the main barriers reported. Discussion and Conclusion Our findings support previous research showing that the decision making of nursing personnel was supported by the use of technology, although several barriers were identified. These insights may help to support further development of CDSSs for use in clinical practice in nursing homes and increase knowledge about effective strategies for implementing CDSSs. References 1.
2.
Randell, R, Mitchell N, Dowding D, Cullum N, Thompson C. Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review. J Health Serv Res Policy, 2007; 12: 242-9. Fossum M, Alexander GL, Ehnfors M, Ehrenberg A. Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly. Int J Med Inf, 2011; 80: 607-617.
School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Centre for Caring Research – Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 3 School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska, Omaha, USA; 4 School of Health and Social Studies, Dalarna University, Falun, Sweden 2
Abstract The aim was to describe the facilitators and barriers influencing the ability of nursing personnel to effectively use a CDSS for planning and treating pressure ulcers and malnutrition in nursing homes. Usability evaluations and group interviews were conducted. Facilitators were ease of use, usefulness and a supportive work environment. Lack of training, resistance to using computers and limited integration of the CDSS with the electronic health record system were reported. Introduction A number of advanced clinical computerized decision support systems (CDSSs) have failed to support nursing personnel in their daily work1. Assessment of what kind of factors may promote or hamper the use, will give valuable knowledge to increase the quality of the CDSSs used by nursing personnel in nursing homes. Systematic usability evaluations conducted in natural settings can provide important knowledge about how to support the nursing personnels’ decision making by technology. Methods This qualitative descriptive study with two usability evaluations and four group interviews was conducted in 2009- 2010 after an intervention study2. The cognitive walkthrough observations had five participants recruited as experts and was conducted in a nursing home. After the observation the participants answered a usability evaluation questionnaire. Three scenarios were used for the cognitive walkthrough observation. A semistructured interview guide was used for the group interviews conducted in four nursing homes where the CDSS had been implemented. Text was analyzed using qualitative content analysis and the quantitative data from the questionnaire was analyzed using statistics in Excel. Results Participants reported that more emphasis was placed on preventing, treating and documenting pressure ulcers and malnutrition after the implementation of the CDSS. CDSS design facilitators were: ease of use, usefulness and a supportive work environment. Lack of training, resistance to using computers and limited integration of the CDSS with the electronic health record system were the main barriers reported. Discussion and Conclusion Our findings support previous research showing that the decision making of nursing personnel was supported by the use of technology, although several barriers were identified. These insights may help to support further development of CDSSs for use in clinical practice in nursing homes and increase knowledge about effective strategies for implementing CDSSs. References 1.
2.
Randell, R, Mitchell N, Dowding D, Cullum N, Thompson C. Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review. J Health Serv Res Policy, 2007; 12: 242-9. Fossum M, Alexander GL, Ehnfors M, Ehrenberg A. Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly. Int J Med Inf, 2011; 80: 607-617.
