Designing a computerized decision support system for asthma chronic disease management in community pharmacies

We previously built and validated the Electronic Asthma Management System (eAMS)-a clinic-based asthma computerized clinical decision support system (CDSS) which is in clinical use.

Herein, we sought to adapt and optimize the eAMS for implementation in community pharmacy practice.

We iteratively developed a system prototype (the eAMS-Pharm) with input from clinical pharmacists, and asthma, knowledge translation, and eHealth experts. After face-validation by three external community pharmacists, we used a rapid-cycle development process for optimization of system design (format), content, and user workflows (usability). This involved a sequential and repeated three-stage process: (1) system prototype demonstration and testing in 90 min, semi-structured virtual focus groups with target end-users; (2) analysis of focus group findings; and (3) corresponding modifications to the prototype, then re-testing in another focus group. This process continued until we reached pre-defined stopping criteria. We used a questionnaire to gather demographic information and further usability data and feedback. Community pharmacy team members were recruited from an existing pharmacy database.

Stopping criteria were met after six focus group cycles with 28 participants [23 (83%) pharmacists, 4 (14%) registered pharmacy technicians/assistants, and 1 (3%) pharmacy student]. User feedback and corresponding system improvements spanned usability, workflow, and prescriber communication domains. The optimized system consisted of a pharmacy portal with a patient dashboard, patient and provider versions of a point-of-care questionnaire, an interactive CDSS producing guideline-based recommendations, automated documentation, and pre-formatted prescriber communications. The System Usability Scale score was 82.9 ± 16.8 (maximum 100), and user responses to Likert scale-based assessments of eAMS-Pharm design, content, workflow, impact, and overall impressions were highly favorable.

We built and optimized a chronic disease CDSS for use in community pharmacies, identifying and addressing pharmacy-specific barriers to implementation. The system achieved a high system usability score and highly favorable ratings for perceived system benefits, likelihood of clinical use, and patient benefits. The eAMS-Pharm can now be evaluated for uptake, care impact, and outcome impact in real-world settings. Our findings surrounding users' design, content, and usability/workflow preferences, and our unique development strategy, can also inform future pharmacy-based chronic disease CDSS design.