User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing...

Area of Science:

• Health Informatics
• Implementation Science
• Human-Computer Interaction

Background:

• Electronic health record-based clinical decision support (CDS) tools face barriers in multi-site adoption due to workflow and user variations.
• Translating evidence-based CDS across heterogeneous environments requires balancing core functionality with contextual adaptations.

Purpose of the Study:

• To develop and apply a framework guiding the tailoring and implementation of CDS across diverse clinical settings.
• To address dissemination and implementation barriers for CDS tools in multi-site trials.

Main Methods:

• Developed the User-Centered Framework for Implementation of Technology (UFIT), integrating user-centered design, human factors/ergonomics, and implementation science.
• Conducted 41 semistructured interviews with pediatric primary care clinicians and stakeholders across 3 US health systems.
• Utilized qualitative interviews for formative evaluation to inform CDS adaptation and implementation strategies.

Main Results:

• Workflow analysis identified 3 key clinician interaction points with electronic health records during well-child visits for decision support opportunities.
• Differences in practice patterns across contexts highlighted the need for a multiprong design approach.
• Identified diverse user needs, preferences, and implementation strategy requirements.

Conclusions:

• The UFIT framework integrates multiple scientific disciplines to enhance the fit of CDS with local contexts for improved outcomes.
• UFIT guided the development of 'Improving Pediatric Obesity Practice Using Prompts,' a CDS package with tailored implementation strategies.
• The framework promotes successful adoption of evidence-based CDS in varied clinical environments.