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CC BY 4.0 · Appl Clin Inform 2025; 16(05): 1531-1540
DOI: 10.1055/a-2716-4479
Research Article

Pragmatic Integration of User-Centered Design and Implementation Science: A New Methodological Approach for Clinical Decision Support Implementation in EHRs

Autoren

  • Anna M. Maw

    1   Division of Hospital Medicine, University of Colorado Anschutz, Aurora, Colorado, United States
    2   Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

  • Jason A. Hoppe

    3   Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States

  • Nicole M. Wagner

    2   Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
    4   Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States

  • James Mitchell

    5   Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

  • Meagan Bean

    2   Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

  • Katy E. Trinkley

    2   Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
    5   Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
    6   Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
    7   Colorado Center for Personalized Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Funding This research was supported by a grant from the American Heart Association's Second Century Implementation Science Award and by the National Institute of Drug Abuse of the National Institutes of Health under Award Number R33DA057610. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Trinkley's time was supported in part by the National Heart, Lung, Blood and Sleep Institute K23HL161352.
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Abstract

Background

Clinical decision support (CDS) tools are critical for improving care delivery and guideline adherence but are associated with clinician burnout when inadequately designed and implemented. User-centered design (UCD) and implementation science (IS) methods are evidence-based approaches to optimizing CDS tools, but are infrequently used in part due to limited guidance on how to apply them within resource-constrained health systems.

Objective

This paper focuses on pragmatic application of an integrated UCD–IS approach, demonstrating how it can be adapted to meet operational constraints through two real-world case studies.

Methods

We applied an integrated UCD–IS approach guided by the Practical Robust Implementation and Sustainability Model (PRISM) to two CDS projects within a large regional health system: (1) adapting a CDS for improving prescribing of goal-directed medical therapy in patients with heart failure during virtual visits, and (2) expanding a naloxone co-prescribing CDS across outpatient settings. Each project followed iterative phases—partner engagement, design, prototyping, deployment, and evaluation tailored to time and resource constraints of the health system. Methods used included interviews, focus groups, surveys, and usability testing.

Results

Multilevel partner engagement surfaced critical insights that informed design adaptations. The heart failure CDS was adapted using minimal changes while the naloxone CDS underwent more extensive design iterations. Both projects balanced rigor and pragmatism, enabling timely implementation and rigorous design evaluation while supporting feasibility and sustainability. Iterative evaluations of both CDS are ongoing and structured to inform real-time refinements that support patient, clinician, and system-level outcomes.

Conclusion

This work provides practical guidance on applying an integrated UCD–IS approach to CDS design and evaluation in time and resource–constrained health system environments. By flexibly applying this integrated approach, health systems can better address multilevel partner needs, ensure contextual relevance, and support sustained adoption.

Keywords

user-centered design - clinical decision support - implementation science - case studies

Protection of Human and Animal Subjects

The studies described were performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and were reviewed by the Colorado Multiple Institutional Review Board.




Publikationsverlauf

Eingereicht: 10. Juni 2025

Angenommen: 26. September 2025

Accepted Manuscript online:
07. Oktober 2025

Artikel online veröffentlicht:
30. Oktober 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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