TY  - JOUR
AU  - Barton, Hanna J
AU  - Maru, Apoorva
AU  - Leaf, Margaret A
AU  - Hekman, Daniel J
AU  - Wiegmann, Douglas A
AU  - Shah, Manish N
AU  - Patterson, Brian W
PY  - 2024
DA  - 2024/4/18
TI  - Academic Detailing as a Health Information Technology Implementation Method: Supporting the Design and Implementation of an Emergency Department–Based Clinical Decision Support Tool to Prevent Future Falls
JO  - JMIR Hum Factors
SP  - e52592
VL  - 11
KW  - emergency medicine
KW  - clinical decision support
KW  - health IT
KW  - human factors
KW  - work systems
KW  - SEIPS
KW  - Systems Engineering Initiative for Patient Safety
KW  - educational outreach
KW  - academic detailing
KW  - implementation method
KW  - department-based
KW  - CDS
KW  - clinical care
KW  - evidence-based
KW  - CDS tool
KW  - gerontology
KW  - geriatric
KW  - geriatrics
KW  - older adult
KW  - older adults
KW  - elder
KW  - elderly
KW  - older person
KW  - older people
KW  - preventative intervention
KW  - team-based analysis
KW  - machine learning
KW  - high-risk patient
KW  - high-risk patients
KW  - pharmaceutical
KW  - pharmaceutical sales
KW  - United States
KW  - fall-risk prediction
KW  - EHR
KW  - electronic health record
KW  - interview
KW  - ED environment
KW  - emergency department
AB  - Background: Clinical decision support (CDS) tools that incorporate machine learning–derived content have the potential to transform clinical care by augmenting clinicians’ expertise. To realize this potential, such tools must be designed to fit the dynamic work systems of the clinicians who use them. We propose the use of academic detailing—personal visits to clinicians by an expert in a specific health IT tool—as a method for both ensuring the correct understanding of that tool and its evidence base and identifying factors influencing the tool’s implementation. Objective: This study aimed to assess academic detailing as a method for simultaneously ensuring the correct understanding of an emergency department–based CDS tool to prevent future falls and identifying factors impacting clinicians’ use of the tool through an analysis of the resultant qualitative data. Methods: Previously, our team designed a CDS tool to identify patients aged 65 years and older who are at the highest risk of future falls and prompt an interruptive alert to clinicians, suggesting the patient be referred to a mobility and falls clinic for an evidence-based preventative intervention. We conducted 10-minute academic detailing interviews (n=16) with resident emergency medicine physicians and advanced practice providers who had encountered our CDS tool in practice. We conducted an inductive, team-based content analysis to identify factors that influenced clinicians’ use of the CDS tool. Results: The following categories of factors that impacted clinicians’ use of the CDS were identified: (1) aspects of the CDS tool’s design (2) clinicians’ understanding (or misunderstanding) of the CDS or referral process, (3) the busy nature of the emergency department environment, (4) clinicians’ perceptions of the patient and their associated fall risk, and (5) the opacity of the referral process. Additionally, clinician education was done to address any misconceptions about the CDS tool or referral process, for example, demonstrating how simple it is to place a referral via the CDS and clarifying which clinic the referral goes to. Conclusions: Our study demonstrates the use of academic detailing for supporting the implementation of health information technologies, allowing us to identify factors that impacted clinicians’ use of the CDS while concurrently educating clinicians to ensure the correct understanding of the CDS tool and intervention. Thus, academic detailing can inform both real-time adjustments of a tool’s implementation, for example, refinement of the language used to introduce the tool, and larger scale redesign of the CDS tool to better fit the dynamic work environment of clinicians. 
SN  - 2292-9495
UR  - https://humanfactors.jmir.org/2024/1/e52592
UR  - https://doi.org/10.2196/52592
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38635318
DO  - 10.2196/52592
ID  - info:doi/10.2196/52592
ER  -