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User-Centered Design and Implementation of an Interoperable FHIR Application for Pediatric Pneumonia Prognostication
Robert W Turer1, Stephen C Gradwohl2, Justine Stassun2
1Department of Emergency Medicine and Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States.
Insights
A prognostic tool for pediatric pneumonia was developed using user-centered design and Fast Healthcare Interoperability Resources (FHIR) standards. This tool supports clinical trials by improving risk communication and data capture in emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Clinical Decision Support
Background:
- Pneumonia prognosis in children requires effective risk communication.
- Electronic Health Record (EHR) integration is crucial for clinical trial support.
- User-centered design (UCD) principles enhance tool adoption in healthcare.
Purpose of the Study:
- To design, test, and deploy a prognostic tool for pediatric pneumonia in emergency departments (EDs).
- To support a pragmatic, EHR-based randomized controlled trial using UCD and interoperable software.
- To improve risk communication and data capture for clinical trial purposes.
Main Methods:
- Applied UCD principles and evidence-based risk communication strategies.
- Developed an integrated SMART on Fast Healthcare Interoperability Resources (FHIR) web application.
- Utilized a UCD framework including user research, prototyping, and evaluations across different EHR vendors (Epic, Cerner).
Main Results:
- User research identified preferences for risk aversion, accessibility, and timing of risk communication.
- Iterative design incorporated numeracy, risk framing, and visualization techniques.
- Successful deployment in two EDs facilitated trial enrollment, randomization, and data capture.
Conclusions:
- Successful implementation highlights the importance of UCD, modern clinical data standards (FHIR), and rigorous testing.
- Key lessons include understanding user needs, knowledge management, and careful FHIR application configuration for interoperability.
- This approach demonstrates a viable method for developing and deploying clinical trial support tools across diverse EHR systems.
Objectives:
To support a pragmatic, electronic health record (EHR)-based randomized controlled trial, we applied user-centered design (UCD) principles, evidence-based risk communication strategies, and interoperable software architecture to design, test, and deploy a prognostic tool for children in emergency departments (EDs) with pneumonia.
Methods:
Risk for severe in-hospital outcomes was estimated using a validated ordinal logistic regression model to classify pneumonia severity. To render the results usable for ED clinicians, we created an integrated SMART on Fast Healthcare Interoperability Resources (FHIR) web application built for interoperable use in two pediatric EDs using different EHR vendors: Epic and Cerner. We followed a UCD framework, including problem analysis and user research, conceptual design and early prototyping, user interface development, formative evaluation, and postdeployment summative evaluation.
Results:
Problem analysis and user research from 39 clinicians and nurses revealed user preferences for risk aversion, accessibility, and timing of risk communication. Early prototyping and iterative design incorporated evidence-based design principles, including numeracy, risk framing, and best-practice visualization techniques. After rigorous unit and end-to-end testing, the application was successfully deployed in both EDs, which facilitated enrollment, randomization, model visualization, data capture, and reporting for trial purposes.
Conclusion:
The successful implementation of a custom application for pneumonia prognosis and clinical trial support in two health systems on different EHRs demonstrates the importance of UCD, adherence to modern clinical data standards, and rigorous testing. Key lessons included the need for understanding users' real-world needs, regular knowledge management, application maintenance, and the recognition that FHIR applications require careful configuration for interoperability.
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