Developing a decision support system for tobacco use counselling using primary care physicians.

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Behavioral Science

Background:

• Clinical decision support systems (CDSS) can improve guideline adherence.
• Physician adoption of CDSS in complex ambulatory clinics is often limited.
• Effective CDSS design must consider the real-world clinical environment.

Purpose of the Study:

• To gather primary care physician input for designing a smoking cessation CDSS.
• To ensure the CDSS design is clinically appropriate before trial testing.
• To provide a generalizable approach for designing similar health informatics systems.

Main Methods:

• Iterative ethnographic process with multiple evaluation methods.
• Prototype development based on physician and clinic manager surveys.
• Usability testing, expert validation, and iterative design refinement.
• Clinical and field testing in primary care settings with practicing physicians.

Main Results:

• The CDSS prototype underwent significant modifications, including the removal of a critical design flaw.
• Physicians successfully integrated the final CDSS into their daily workflow.
• The CDSS was utilized for smoking cessation interventions up to eight times per day.

Conclusions:

• A multi-method evaluation involving primary care physicians is effective for CDSS development.
• The developed CDSS was found to be acceptable to physicians and patients.
• The CDSS proved feasible for integration and use within a clinical environment.