Health Information Technology-Supported Process for Preventing and Managing Venous Thromboembolism

Venous thromboembolism (VTE) is a serious complication for hospitalized patients and may lead to a pulmonary embolism (PE), a significant cause of morbidity and mortality. With proper management, VTE in hospitalized patients is largely preventable. Health information technology (IT) such as electronic reminders and clinical decision support (CDS) for assessing VTE risk can be used to improve VTE prevention and management. However, studies have shown that its effectiveness is limited by a range of sociotechnical issues, including poor technology interface design and fit of the technology with clinical workflow and clinician information needs. The purpose of this research study was to develop design requirements for effective CDS for VTE prevention and diagnosis using a sociotechnical systems approach, which focuses on interactions between people and technology in the workplace.

The specific aims of the research were as follows:

• Evaluate the cognitive and team work involved in VTE prevention (i.e., prophylaxis) and diagnosis. 
• Develop design requirements for a computerized CDS that supports cognitive and team work for preventing and diagnosing VTE. 

The study was conducted in four hospitals in Pennsylvania and Wisconsin and involved physicians, advanced practice providers, nurses, and pharmacists in multiple hospital services and units and in emergency departments.

For the first aim, focused on understanding the VTE prophylaxis process in the hospital, the investigators conducted a mixed-methods, observational study using interviews, focus groups, observations, surveys, and individual feedback sessions. For the second aim, the investigators conducted interviews and focus groups to understand the VTE diagnostic process and conducted a quasi-experimental study to compare the human factors-based CDS, called PE Dx, with an existing online CDS for PE.

The study team developed two lists of design requirements for VTE prophylaxis and VTE diagnosis, and then designed and evaluated the PE Dx CDS to support VTE diagnosis for ED patients. Usability was found to be higher on all dimensions as compared to the existing online CDS for PE, demonstrating the value of using human factors methods and principles for designing this tool. These results also show the need for a sociotechnical systems approach that uses multiple methods for collecting and analyzing data, involves multiple perspectives and disciplines, and considers health IT in the broader work system context.