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Applying Realist Retroduction to EHR-Based Clinical Decision Support Tool Development.

Suzanne Morrissey1,2, Arwen Bunce1, Jenna Donovan1

  • 1OCHIN, Inc., Portland, OR, USA.

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|August 28, 2025
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Summary
This summary is machine-generated.

Realist retroduction enhanced the development of electronic health record (EHR)-based clinical decision support tools. This approach improved tool design by identifying user needs before a formal trial, optimizing interventions for social determinants of health.

Keywords:
clinical decision supportelectronic health recordrealist evaluationretroductionsocial determinants of health

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Area of Science:

  • Implementation Science
  • Health Services Research
  • Realist Evaluation

Background:

  • Social determinants of health interventions require understanding of context for effectiveness.
  • Electronic health record (EHR)-based clinical decision support tools can address social determinants of health.
  • Implementation research benefits from understanding intervention mechanisms and contextual factors.

Purpose of the Study:

  • To demonstrate the application of realist retroduction in intervention development.
  • To refine EHR-based clinical decision support tools using realist principles.
  • To improve the desirability and use of tools addressing patient-reported insecurities.

Main Methods:

  • Applied realist principles, specifically realist retroduction, during the mid-study development phase.
  • Used study development data to inform retroductive steps and identify tentative program theories.
  • Iteratively revised five EHR-based clinical decision support tools based on retroductive findings.

Main Results:

  • Realist retroduction effectively identified intangible clinical needs and preferences impacting tool desirability and use.
  • The iterative revision process, guided by retroduction, improved the pilot tools before the formal trial.
  • Tentative program theories were identified, informing tool revisions to better meet clinical needs.

Conclusions:

  • Realist retroduction is a valuable method for intervention development in implementation research.
  • Applying retroductive thinking pre-trial optimizes interventions for real-world conditions.
  • This pragmatic approach facilitates researcher/stakeholder co-design, enhancing intervention effectiveness and efficiency.