Integrating PRISM with User-centered Design (PRISM+UCD): Designing clinical decision support for safe opioid...

Balancing safe opioid prescribing with effective pain management is essential to addressing the opioid crisis. Increasing clinician adoption of evidence-based safety practices is a public health priority. This project presents a practical, adaptable approach to developing electronic health record (EHR)-embedded clinical decision support (CDS) strategies that promote uptake of opioid safety measures recommended by the Centers for Disease Control and Prevention (CDC). The goal was to design implementation strategies that enhance guideline-concordant opioid prescribing, including a suite of EHR-integrated CDS tools.

Guided by the Practical, Robust Implementation and Sustainability Model (PRISM) and informed by implementation science and user-centered design (UCD), we used an iterative, multi-level engagement process. PRISM served as the theoretical framework for integrating collaborator input and user testing throughout the development cycle. Activities included discovery, design, prototyping, and usability testing. Collaborators included executive decision-makers, informatics leaders, frontline clinicians across diverse settings, representatives from the CDC and National Institute on Drug Abuse, and patients. These methods informed the selection of opioid safety measures, design themes, and workflow considerations, resulting in implementation-ready CDS prototypes.

The discovery phase identified a naloxone prescribing alert as a strong candidate for redesign, aligning with CDC guidelines and relevant across all four PRISM domains. The final redesign received mean ratings of 4.0 and 4.2 out of 5 on the Acceptability of Intervention Measure (AIM) from inpatient and outpatient clinicians, respectively.

Despite substantial public and governmental attention and investment, the opioid crisis in the United States continues to pose a serious threat to public health.¹ In 2023, 8.6 million people across the U.S. misused opioids.² In 2022, there were 81,806 opioid-related deaths in the U.S.¹ The overall rate of unintentional overdoses was 4.3% for prescription opioids and 28.7% for any opioids.³ These figures underscore the urgent need for strategies that enhance safety at the point of care, specifically when clinicians prescribe opioids, while minimizing disruption to clinical workflows and ensuring applicability across diverse healthcare settings. Opioid therapy is prescribed in a wide range of clinical contexts by various types of clinicians, from primary care to specialty and emergency care. This paper outlines the process and results of co-designing clinical decision support (CDS) tools to aid clinicians in safe opioid prescribing, drawing on implementation science and user-centered design (UCD) frameworks.