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Assessing Clinical Software User Needs for Improved Clinical Decision Support Tools Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2015 Assessing Clinical Software User Needs for Improved Clinical Decision Support Tools Kimberly B. Denney Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Databases and Information Systems Commons, Health and Medical Administration Commons, and the Library and Information Science Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Management and Technology This is to certify that the doctoral study by Kimberly Denney has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Craig Martin, Committee Chairperson, Doctor of Business Administration Faculty Dr. Edward Paluch, Committee Member, Doctor of Business Administration Faculty Dr. Lynn Szostek, University Reviewer, Doctor of Business Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract Assessing Clinical Software User Needs for Improved Clinical Decision Support Tools by Kimberly B. Denney MBA, University of Miami, 2003 BS, Indiana University, 1984 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Business Administration Walden University October 2015 Abstract Consolidating patient and clinical data to support better-informed clinical decisions remains a primary function of electronic health records (EHRs). In the United States, nearly 6 million patients receive care from an accountable care organization (ACO). Knowledge of clinical decision support (CDS) tool design for use by physicians participating in ACOs remains limited. The purpose of this quantitative study was to examine whether a significant correlation exists between characteristics of alert content and alert timing (the independent variables) and physician perceptions of improved ACO quality measure adherence during electronic ordering (the dependent variable). Sociotechnical theory supported the theoretical framework for this research. Sixty-nine physician executives using either a Cerner Incorporated or Epic Systems EHR in a hospital or health system affiliated ACO participated in the online survey. The results of the regression analysis were statistically significant, R2 = .108, F(2,66) = 3.99, p = .023, indicating that characteristics of alert content and timing affect physician perceptions for improving their adherence to ACO quality measures. However, analysis of each independent variable showed alert content highly correlated with the dependent variable (p = .007) with no significant correlation found between workflow timing and the dependent variable (p = .724). Understanding the factors that support physician acceptance of alerts is essential to third-party software developers and health care organizations designing CDS tools. Providing physicians with improved EHR-integrated CDS tools supports the population health goal of ACOs in delivering better patient care. Assessing Clinical Software User Needs for Improved Clinical Decision Support Tools by Kimberly B. Denney MBA, University of Miami, 2003 BS, Indiana University, 1984 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Business Administration Walden University October 2015 Dedication I dedicate this work to my husband, Lamar. You never complained when I chose to study for classes and write papers on the weekend instead of spending that time with you. Instead, you were a constant source of encouragement and strength. I became concerned with letting you down if I failed to finish this endeavor further igniting my determination to buckle down and get it done. You are the love of my life and my life’s partner. I thank you, and I count my blessings to be able to continue enjoying our life’s journey together. Acknowledgments I am thankful to share this accomplishment with my children, Jake and Joey and my parents, Marty and Tom Brodsky. They provided needed encouragement while grounding me in my life’s purpose. Lamar, as stated before, takes top honors for cheerleading and for always maintaining a perfect “command central.” I must acknowledge our two pugs, Magnus and Ceasar. Magnus left me with great memories of his companionship and snoring through long periods of study. Ceasar continues to provide his unwavering support, always game to accompany me in my office whether for one hour or for eight. I also want to thank my faculty. My Chair, Dr. Craig Martin provided positive encouragement at every stage. My second committee member, Dr. Edward Paluch and my URR, Dr. Lynn Szostek were equally supportive facilitating the completion of this work. I also want to acknowledge Dr. Jim Goes who first put me on the path of a quantitative study. Along my journey at Walden University, many students became important colleagues and part of my network contributing to my success. I thank all of the Walden staff and my fellow students who supported my efforts. I also acknowledge my coworkers and many professional peers who provided counsel and willingly provided their feedback, support, and encouragement. Specifically, Dr. Jeff Borenstein served as an important mentor to me during the last year of this program. And, I must acknowledge the support of my community partner, AMDIS. Dr. William Bria was exceptionally accommodating to this novice researcher. Thank you very much! Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Section 1: Foundation of the Study ......................................................................................1 Background of the Problem ...........................................................................................1 Problem Statement .........................................................................................................2 Purpose Statement ..........................................................................................................2 Nature of the Study ........................................................................................................3 Research Question .........................................................................................................5 Hypotheses .....................................................................................................................5 Survey Questions .................................................................................................... 6 Theoretical Framework ..................................................................................................6 Definition of Terms ........................................................................................................8 Assumptions, Limitations, and Delimitations ..............................................................10 Assumptions .......................................................................................................... 10 Limitations ............................................................................................................ 11 Delimitations ......................................................................................................... 11 Significance of the Study .............................................................................................12 Contribution to Business Practice ......................................................................... 12 Implications for Social Change ............................................................................. 12 A Review of the Professional and Academic Literature ..............................................13 Legislation and EHR Use ...................................................................................... 14 The ACO Model ................................................................................................... 15 i Achieving MU of EHRs ........................................................................................ 18 Application of Sociotechnical Theory .................................................................. 20 Rival Theories ....................................................................................................... 24 Discussion of the Independent Variables .............................................................. 30 Independent Variable A: Type of CDS Tool ........................................................ 32 Independent Variable B: Workflow Timing ......................................................... 35 Methodologies Supporting the Dependent Variable ............................................. 37 Overcoming Current EHR Limitations ................................................................. 44 Future CDS Research Opportunities ..................................................................... 54 Summary ..............................................................................................................
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