Academic detailing as a health information technology implementation method: Supporting the design and implementation of an emergency department-based clinical decision support tool to prevent future falls (Preprint)

Abstract

Clinical decision support (CDS) tools that incorporate machine learning-derived content have the potential to transform clinical care by augmenting clinicians’ expertise. To realize this potential, such tools must be designed to fit the dynamic work systems of the clinicians who use them. We propose the use of academic detailing—personal visits to clinicians by an expert in a specific health IT tool—as a method for both ensuring the correct understanding of that tool and its evidence base and identifying factors influencing the tools’ implementation.

To assess academic detailing as a method for simultaneously ensuring the correct understanding of an ED-based CDS tool to prevent future falls and identifying factors impacting clinicians’ use of the tool.

Previously, our team designed a CDS tool to identify patients 65+ who are at highest risk of future falls and prompt an interruptive alert to clinicians suggesting the patient be referred to a Mobility and Falls Clinic for an evidence-based preventative intervention. We conducted 10-minute academic detailing interviews (n=16) with resident emergency medicine physicians and advanced practice providers who had encountered our CDS tool in practice. We conducted an inductive, team-based content analysis to identify factors that influenced clinicians’ use of the CDS tool.

The following categories of factors that impacted clinicians’ use of the CDS were identified: (1) aspects of the CDS tool’s design (2) clinicians’ understanding (or misunderstanding) of the CDS or referral process, (3) the busy nature of the ED environment, (4) clinicians’ perceptions of the patient and their associated fall-risk, and (5) the opacity of the referral process. Additionally, clinician education was done to address any misconceptions about the CDS tool or referral process, e.g., demonstrating how simple it is to place a referral via the CDS and clarifying which clinic the referral goes to.

Our study demonstrates the utility of academic detailing for supporting the implementation of HIT: allowing us to identify factors that impacted clinicians’ use of the CDS while concurrently educating clinicians to ensure the correct understanding and use of the CDS tool and intervention. Thus, academic detailing can inform real-time adjustments of a tool’s implementation, e.g., refinement of the language used to introduce the tool, etc., and larger-scale redesign of the CDS tool to better fit the dynamic work environment of clinicians.

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