Ray JM, Ahmed OM, Solad Y, et al. (2019). Computerized clinical depression support system for emergency department-initiated buprenorphine for opioid use disorder: User-centered design. JMIR Human Factors. 6(1): e13121. doi: 10.2196/13121
The EMergency department-initiated Buprenorphine for opioid usE Disorder (EMBED) clinical decision support (CDS) tool was developed to support emergency department (ED) initiation of buprenorphine for patients with opioid use disorder (OUD). User testing of the EMBED tool was conducted in 5 phases with 26 unique participants, including physicians, administrative staff, and addiction counselors from the ED at an urban academic trauma center. Design phases included: 1) a needs assessment involving discussions with content and context experts and ethnographic observations of physicians and administrative staff; 2) development of a low fidelity prototype and review by design team members, a content area expert, physicians, and administrative leadership; 3) iterative design cycles involving prototype development, review by physicians, and prototype refinement; 4) review of a final prototype with physicians; and 5) tool finalization. The needs assessment emphasized that the EMBED tool should enable proper patient identification, facilitate better clinician understanding of OUD treatment, and integrate with existing workflows. Feedback in the second phase and design cycles in the third phase focused on design improvements, improvements in clarity, and streamlining. Minor changes were made in the fourth phase to improve clarity and all participants found the tool was easy to learn and feasible to use in practice. The final iteration of the EMBED tool was embedded in electronic health records and presented care pathways in separate columns with options to initiate individual care pathways or initiate CDS for OUD diagnosis, assessing withdrawal, and motivational interviewing along the side of the tool.