Clinical decision support system for child and adolescent mental health services: a formative usability study

Child and adolescent mental disorders are creating significant demands on Norway's general and specialized health services. Addressing these demands requires innovative approaches to increase workforce numbers and effectiveness. The Individualized Digital Decision Assist System (IDDEAS) is a Clinical Decision Support System (CDSS) for child and adolescent mental health services in Norway. IDDEAS 1.0 is a guidelines-based prototype with attention-deficit/hyperactivity disorder (ADHD) as the first model clinical paradigm. IDDEAS 1.0 is the focus of a formative usability study to examine clinicians' information processing needs and their perceptions of the acceptability, functionality and ease of interactions with user interface (UI) and user-experience (UX).

In collaboration with the Norwegian Association for Child and Adolescent Mental Health (N-BUP) a provisional list of practitioners in child and adolescent mental health services (CAMHS) was compiled for recruitment of potential participants. Child and adolescent psychologists and psychiatrists (n = 68) completed IDDEAS formative usability testing. Study participants also completed a think-aloud protocol in which they verbalized their thoughts about the experience in real time while assessing hypothetical patient case vignettes. By observing these representative, potential IDDEAS users, developers gain insight from their interactions with the prototype. A self-developed display and functional ease-of-use questionnaire, as well as the IDDEAS modified system usability scale and user engagement scales, were completed. All qualitative data were analyzed using both protocol analysis and content analysis.

Examination of the formative usability identified a participant appreciation of the side-by-side guideline/patient view, simplistic UI presentation, and alignment with their diagnostic routines. 89% of usability comments informed next-step improvements pinpointing forced linear navigation, ADHD focused prototype, and ambiguous prompts. This resulted in proposed enhancements centered on dynamic criteria selection, optional guideline choice, individualized content, and seamless electronic health records integration.

The scenario-based exploration of the IDDEAS 1.0 prototype allowed CAMHS clinicians to offer honest reflections about receiving decision-support, and what they might potentially need for such support to enhance their clinical decision-making and information processing at the point of care. Functional adjustments in IDDEAS were recommended, with a focus on workflow cohesion and individualized adaptability for optimal ease of use and personalized patient care.