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A design research was undertaken to identify ways to help clinicians to efficiently and accurately address medical guidelines for treating heart failure.
[2020]
There is strong scientific evidence from several clinical trials indicating to the benefit of guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF). Despite the evidence, significant gaps in prescribing GDMT persist across health systems, resulting in poor clinical outcomes.
Team
Ryan Ahmed, Sarah Colletta, Victor Cornet, Carly Daley, Shauna Wagner, Tammy Toscos, Michael Mirro, MD (Parkview Research), Roy Robertson, MD (Parkview Heart Institute)
Objective
A design study was undertaken as part of a larger research supported by an American College of Cardiology (ACC) innovation award to understand the workflow of typical heart failure office visits with and without pharmacist consult, identify opportunities for technological intervention and outline recommendations.
Process
Contextual Inquiry
Cardiology providers in two separate areas of care, one without a pharmacist and one with a pharmacist integrated in the workflow, were observed in natural work settings during patient visits. Consolidated work model diagrams were constructed to explore work process and potential areas of breakdown related to prescribing and tracking the status of GDMT.
Scenario Testing
Providers participating in the contextual inquiry were also presented with a mock HFrEF patient appointment during their regular work where the test patient is not on GDMT. Chart review process and steps taken to meet GDMT for the test patient were observed alongside brief interview questions for analysis contributing to work model diagrams.
Wireframing
Wireframe sketches were developed for recommended tools to support the clinical workflow for improved GDMT management in cardiology practice based on study findings including an at-a-glance GDMT status view integrated in the patient chart with quick actions to address or document exception, and an option to subscribe to updates from a future referral visit in a distributed care setting.
What could interviews or focus group yield? Users are habituated and do not report any problem in this day-to-day work routine.
Consolidated workflow and potential breakdowns identified from contextual inquiry.
Prototype of a snapshot view in the patient chart offered as one recommendation to aid clinical review and decision-making.
Outcome
Summary of problems identified:
Communication gaps
Lost referrals
Collaborative decisions made outside of patient chart
Incomplete GDMT
Unorganized data
Many sources of information
Unstructured data in notes
Variable workflow
No standard process regarding GDMT
Complexity of distributed care
Recommendations resulting from the study are under evaluation to be integrated into existing practice for a pilot trial.
Publications
Robertson, Roy MD; Ahmed, Ryan; Toscos, Tammy PhD; Cornet, Victor P. MS; Wagner, Shauna; Colletta, Sarah; Daley, Carly; and Mirro, Michael MD (2020). Technology and Workflow Recommendations to Improve Use of Guideline Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction. 2020 ACC Quality Summit.
More Information
Project Summary at Parkview Health Services and Informatics Research: Guideline-Directed Medication Therapy for Heart Failure with Reduced Ejection Fraction
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