BACKGROUND
The availability of patient outcomes-based feedback is limited in episodic care environments like the emergency department (ED). Emergency medicine (EM) clinicians set care trajectories for a majority of hospitalized patients and provide definitive care to an even larger number of those discharged into the community. EM clinicians are often unaware of short- and long-term health outcomes of patients and how their actions may have contributed. Despite large volumes of patients and data, outcomes-driven learning that targets individual clinician experiences is meager. Integrated electronic health record (EHR) systems provide opportunity, but do not have readily available functionality intended for outcomes-based learning.
OBJECTIVE
This study sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes feedback platform for EM clinicians. Here, we describe the iterative development of this platform, Linking Outcomes of Patients (LOOP), under a human-centered design (HCD) framework, including structured feedback obtained from its use.
METHODS
This multi-modal study consisting of human-centered design studios, surveys (24 physicians), interviews (11 physicians), and a LOOP application usability evaluation (12 EM physicians for > 30 min each) was performed between August 2019 and February 2021. The study spanned 3 phases: (1) conceptual development under a human-centered design framework, (2) LOOP technical platform development, and (3) usability evaluation comparing pre- and post-LOOP feedback gathering practices in the EHR.
RESULTS
An initial HCD studio and EM clinician surveys revealed common themes of disconnect between EM clinicians and their patients post-encounter. Fundamental post-encounter outcomes of death (63% respondents identified as useful), escalation of care (83%), and return to ED (67%) were determined high yield for demonstrating proof-of-concept in our LOOP application. The studio aided the design and development of LOOP, which integrated physicians throughout the design and content iteration. A final LOOP prototype enabled usability evaluation and iterative refinement prior to launch. Usability evaluation compared to status quo (i.e., pre-LOOP) feedback gathering practices demonstrated a shift – across all outcomes – from ‘not easy’ to ‘very easy’ to obtain and from ‘not confident’ to ‘very confident’ in estimating outcomes after using LOOP. On a scale from 0 (unlikely) to 10 (most likely), the users were very likely (9.5) to recommend LOOP to a colleague.
CONCLUSIONS
This study demonstrates the potential for human-centered design of a patient-outcomes driven feedback platform for individual EM providers. We have outlined a framework for working along-side clinicians with a multi-disciplined team to develop and test a tool that augments their clinical experience and enables closed-loop learning.
CLINICALTRIAL