User-Centered Design of a Clinical Tool for Shared Decision-making About Diet in Primary Care.

BACKGROUND: Health information technology is a leading cause of clinician burnout and career dissatisfaction, often because it is poorly designed by nonclinicians who have limited knowledge of clinicians' information needs and health care workflow. OBJECTIVE: Describe how we engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. DESIGN: Descriptive study of the steps followed when involving clinicians and their at-risk patients in the design of the content, layout, and flow of an application for collaborative dietary goal setting. This began with individual clinician and patient interviews to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. PARTICIPANTS: Primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. MAIN MEASURES: Descriptions of the content, format, and flow of information from pre-visit dietary history to the display of evidence-based, guideline-driven suggested goals to final display of dietary goals selected, with information on how the patient might reach them and patients' confidence in achieving them. KEY RESULTS: Through three iterations of design and review, there was substantial evolution of the program's content, format, and flow of information. This involved "tuning" of the information desired: from too little, to too much, to the right amount displayed that both clinicians and patients believed would facilitate shared dietary goal setting. CONCLUSIONS: Clinicians' well-founded criticisms of the design of health information technology can be mitigated by involving them and their patients in the design of such tools that clinicians may find useful, and use, in their everyday medical practice.

Nutri: A Behavioral Science-Based Clinical Decision Support for Chronic Disease Management.

Clinical decision support systems (CDSS) for the ongoing decision making required to support health behavior change for chronic disease management should incorporate behavioral science (e.g., a collaborative goal setting workflow) with more common CDSS components (i.e., an evidence-based knowledge base that processes patient data). Given known challenges with CDSS usability and adoption, engaging clinician end-users in designing new CDSS is vital. Therefore, we tested Nutri, a CDSS for collaborative diet goal setting, with 10 clinicians in a simulated primary care appointment with a patient actor. Simulation recordings, usability surveys, and debriefing interviews provided a multi-method view of clinicians' perceptions of Nutri's value and usability. 100% of participating clinicians achieved Nutri's main objective: selecting a high impact diet goal during a collaborative goal setting discussion with the patient; participants found Nutri usable, potentially timesaving, and increased their diet counseling self-efficacy. Insights will improve Nutri's usability and clinical workflow integration.