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Integrating PRISM with User-centered Design (PRISM+UCD): Designing clinical decision support for safe opioid
Brad Morse1, Katy E Trinkley1, Jason A Hoppe1
1University of Colorado Anschutz Medical Campus.
Research Square
|August 20, 2025
Summary
This study developed electronic health record (EHR)-embedded clinical decision support (CDS) tools to enhance safe opioid prescribing practices. The redesigned naloxone prescribing alert was highly accepted by clinicians, promoting guideline-concordant care.
Area of Science:
- Health Informatics
- Implementation Science
- Public Health
Background:
- The opioid crisis remains a significant public health threat, necessitating improved opioid prescribing safety.
- Effective pain management requires balancing safety with patient needs, particularly in diverse clinical settings.
- There is an urgent need for point-of-care strategies to enhance opioid prescribing safety and reduce misuse and overdose deaths.
Purpose of the Study:
- To develop practical, adaptable electronic health record (EHR)-embedded clinical decision support (CDS) strategies.
- To promote clinician adoption of Centers for Disease Control and Prevention (CDC)-recommended opioid safety measures.
- To design implementation strategies that enhance guideline-concordant opioid prescribing through EHR-integrated CDS tools.
Main Methods:
- Utilized the Practical, Robust Implementation and Sustainability Model (PRISM) and user-centered design (UCD) principles.
- Employed an iterative, multi-level engagement process with diverse stakeholders, including clinicians and patients.
- Conducted discovery, design, prototyping, and usability testing to inform CDS tool development.
Main Results:
- Identified a naloxone prescribing alert as a key candidate for redesign, aligning with CDC guidelines.
- The redesigned naloxone alert achieved high acceptability ratings from both inpatient (4.0/5) and outpatient (4.2/5) clinicians.
- Developed implementation-ready CDS prototypes tailored to clinical workflows and diverse healthcare settings.
Conclusions:
- Co-designing EHR-integrated CDS tools with implementation science and UCD frameworks can effectively promote opioid safety measures.
- User-centered development and multi-stakeholder engagement are crucial for creating acceptable and practical clinical interventions.
- These strategies enhance guideline-concordant opioid prescribing and support efforts to mitigate the opioid crisis.
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