Appl Clin Inform 2020; 11(04): 635-643
DOI: 10.1055/s-0040-1715895
Research Article

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

Joan S. Ash
1  Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
,
Dian Chase
1  Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
,
Sherry Baron
2  Department of Urban Studies, Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, New York, United States
,
Margaret S. Filios
3  National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention, Cincinnati, Ohio and Morgantown, West Virginia, United States
,
Richard N. Shiffman
4  Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut, United States
,
Stacey Marovich
3  National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention, Cincinnati, Ohio and Morgantown, West Virginia, United States
,
Jane Wiesen
1  Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
,
Genevieve B. Luensman
3  National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention, Cincinnati, Ohio and Morgantown, West Virginia, United States
› Author Affiliations
Funding This project was supported by CDC/NIOSH Contract 200–2015–61837 as part of NORA project no.: 927ZLDN. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Abstract

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.

Protection of Human and Animal Subjects

This study was approved by the Institutional Review Boards (IRBs) at NIOSH, Oregon Health & Science University (OHSU), and two of our study sites. IRB waivers and/or official determinations (if a site did not have an IRB, it had other mechanisms for reviewing our protocol) were also obtained from the other three sites.


Supplementary Material



Publication History

Received: 18 May 2020

Accepted: 27 July 2020

Publication Date:
30 September 2020 (online)

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