VA is Enhancing API-Based Clinical Decision Support Tools

The Department of Veterans Affairs is leveraging API-based platforms to improve clinical decision support, combat challenges with clinician burnout and enhance patient care.

“If you think about the number of different applications a doctor has to open in the course of a regular patient encounter, and how incredibly taxing that can be … you can see the cognitive fatigue start to build up,” Lauren Alexanderson, deputy chief technology officer of Health Delivery at VA’s Office of Information Technology, said during a panel at the HIMSS conference in Chicago. “What are the things that we can do to better map the EHR interfaces to efficient workflows?”

To tackle this, VA is building a platform upon which the agency can launch and host context-aware clinical decision support applications that provide common, cohesive clinical experiences to run within its EHRs. As the agency added additional use cases, Alexanderson said her team began to take a “platform approach,” creating repeatable processes to drive a seamless experience.

“As we’re looking toward the future, we’re really trying to figure out how to better embed the clinical decision support into the actual EHR,” Alexanderson said. “The seamless opening of the right application at the right time could make a tremendous difference. So, one of the things we’re playing around with is looking to the low-ish hanging fruit of [clinical decision support] capabilities, where we can be able to launch clinical decision support applications within our different EHR workflows.”

VA has developed eight UX design principles guiding clinical decision support tools:

• Complement and supplement EHR functionality, don’t replace it
• Maximize clarity, minimize noise
• Provide guidance and instill confidence with non-obtrusive feedback loops
• Facilitate insights and health outcomes over information and metrics
• Bridge clinical decisions and clinical actions
• Support clinicians’ sense of control, even when control may be limited
• Configuration, not customization, that supports clinician workflow preferences and needs
• Deliver consistency through a total system approach, thinking about process, outcome and experience.

“Our hope is that these principles will not just infuse the application with norms for developing products, but with actual values that are aligned to how doctors really, truly function. And then these principles could be north stars for how we make design choices for our future decision applications,” Alexanderson said.

VA developed a clinical decision support application to assist clinicians during the height of the COVID-19 pandemic. The agency worked with doctors to understand their needs and reduce workforce burden.

The COVID-19 Patient Manager, gave interactive, intuitive visuals that indicated patient severity of symptoms to help doctors maximize clarity, minimize noise and facilitate the insights and outcomes over information and metrics. The tool also enabled doctors to make informed decisions more quickly.

“They needed to be able to quickly pull together relevant patient data, and they needed an aggregated, organized, updated and trustworthy version of the guidance presented to them in a way that they can use,” Alexanderson said. “We were able to aggregate that patient data and bring them together in a way to sort of supplement the EHR functionality as opposed to trying to replace it.”