{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:27:07Z","timestamp":1779359227012,"version":"3.51.4"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"crossref","award":["1K01DA056698,R33DA057610"],"award-info":[{"award-number":["1K01DA056698,R33DA057610"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"crossref","award":["K23HL161352"],"award-info":[{"award-number":["K23HL161352"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"crossref","award":["23SCISA1144584"],"award-info":[{"award-number":["23SCISA1144584"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Clinical decision support (CDS) tools are critical for improving care delivery and guideline adherence but are associated with clinician burnout when inadequately designed and implemented. User-centered design (UCD) and implementation science (IS) methods are evidence-based approaches to optimizing CDS tools, but are infrequently used in part due to limited guidance on how to apply them within resource-constrained health systems.<\/jats:p>\n                  <jats:p>This paper focuses on pragmatic application of an integrated UCD\u2013IS approach, demonstrating how it can be adapted to meet operational constraints through two real-world case studies.<\/jats:p>\n                  <jats:p>We applied an integrated UCD\u2013IS approach guided by the Practical Robust Implementation and Sustainability Model (PRISM) to two CDS projects within a large regional health system: (1) adapting a CDS for improving prescribing of goal-directed medical therapy in patients with heart failure during virtual visits, and (2) expanding a naloxone co-prescribing CDS across outpatient settings. Each project followed iterative phases\u2014partner engagement, design, prototyping, deployment, and evaluation tailored to time and resource constraints of the health system. Methods used included interviews, focus groups, surveys, and usability testing.<\/jats:p>\n                  <jats:p>Multilevel partner engagement surfaced critical insights that informed design adaptations. The heart failure CDS was adapted using minimal changes while the naloxone CDS underwent more extensive design iterations. Both projects balanced rigor and pragmatism, enabling timely implementation and rigorous design evaluation while supporting feasibility and sustainability. Iterative evaluations of both CDS are ongoing and structured to inform real-time refinements that support patient, clinician, and system-level outcomes.<\/jats:p>\n                  <jats:p>This work provides practical guidance on applying an integrated UCD\u2013IS approach to CDS design and evaluation in time and resource\u2013constrained health system environments. By flexibly applying this integrated approach, health systems can better address multilevel partner needs, ensure contextual relevance, and support sustained adoption.<\/jats:p>","DOI":"10.1055\/a-2716-4479","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T23:09:40Z","timestamp":1759878580000},"page":"1531-1540","source":"Crossref","is-referenced-by-count":3,"title":["Pragmatic Integration of User-Centered Design and Implementation Science: A New Methodological Approach for Clinical Decision Support Implementation in EHRs"],"prefix":"10.1055","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06847906","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Anna M.","family":"Maw","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, University of Colorado Anschutz, Aurora, Colorado, United States"},{"name":"Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason A.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole M.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States"},{"name":"Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meagan","family":"Bean","sequence":"additional","affiliation":[{"name":"Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katy E.","family":"Trinkley","sequence":"additional","affiliation":[{"name":"Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States"},{"name":"Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States"},{"name":"Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States"},{"name":"Colorado Center for Personalized Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1055\/s-0040-1701986","article-title":"Clinical decision support and implications for the clinician burnout crisis","volume":"29","author":"I Jankovic","year":"2020","journal-title":"Yearb Med Inform"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1177\/21501319231166921","article-title":"Burnout related to electronic health record use in primary care","volume":"14","author":"J Budd","year":"2023","journal-title":"J Prim Care Community Health"},{"key":"ref3","first-page":"445","volume-title":"Encyclopedia of Human-Computer Interaction","author":"C Abras","year":"2004"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1006\/ijhc.2001.0503","article-title":"Methods to support human-centred design","volume":"55","author":"M Maguire","year":"2001","journal-title":"Int J Hum Comput Stud"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1007\/s43477-024-00134-6","article-title":"The application and evolution of the Practical, Robust Implementation and Sustainability Model (PRISM): history and innovations","volume":"4","author":"R E Glasgow","year":"2024","journal-title":"Glob Implement Res Appl"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"L J Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"ref7","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780197660690.001.0001","volume-title":"Dissemination and Implementation Research in Health: Translating Science to Practice","author":"R C Brownson","year":"2023"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s43058-020-00020-w","article-title":"Aligning implementation and user-centered design strategies to enhance the impact of health services: results from a concept mapping study","volume":"1","author":"A R Dopp","year":"2020","journal-title":"Implement Sci Commun"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"207","DOI":"10.7326\/0003-4819-157-3-201208070-00012","article-title":"Implementing the learning health system: from concept to action","volume":"157","author":"S M Greene","year":"2012","journal-title":"Ann Intern Med"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1093\/jamia\/ocad109","article-title":"Comparative effectiveness of generic commercial versus locally customized clinical decision support tools to reduce prescription of nonsteroidal anti-inflammatory drugs for patients with heart failure","volume":"30","author":"C Shakowski","year":"2023","journal-title":"J Am Med Inform Assoc"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"e24359","DOI":"10.2196\/24359","article-title":"Applying clinical decision support design best practices with the practical robust implementation and sustainability model versus reliance on commercially available clinical decision support tools: randomized controlled trial","volume":"9","author":"K E Trinkley","year":"2021","journal-title":"JMIR Med Inform"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ijmedinf.2017.05.004","article-title":"User-centered design to improve clinical decision support in primary care","volume":"104","author":"J Brunner","year":"2017","journal-title":"Int J Med Inform"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jbi.2017.01.009","article-title":"User-centered design improves the usability of drug-drug interaction alerts: experimental comparison of interfaces","volume":"66","author":"D R Luna","year":"2017","journal-title":"J Biomed Inform"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s13012-022-01226-3","article-title":"Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem","volume":"17","author":"R S Beidas","year":"2022","journal-title":"Implement Sci"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s43058-023-00494-4","article-title":"The iPRISM webtool: an interactive tool to pragmatically guide the iterative use of the Practical, Robust Implementation and Sustainability Model in public health and clinical settings","volume":"4","author":"K E Trinkley","year":"2023","journal-title":"Implement Sci Commun"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1093\/tbm\/iby119","article-title":"A glossary of user-centered design strategies for implementation experts","volume":"9","author":"A R Dopp","year":"2019","journal-title":"Transl Behav Med"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1055\/s-0043-1775566","article-title":"Sustained effect of clinical decision support for heart failure: a natural experiment using implementation science","volume":"14","author":"K E Trinkley","year":"2023","journal-title":"Appl Clin Inform"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"108745","DOI":"10.1016\/j.pec.2025.108745","article-title":"Applications in human-centered design: shared-decision making for mental health treatment in primary care","volume":"136","author":"K Tirtanadi","year":"2025","journal-title":"Patient Educ Couns"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC clinical practice guideline for prescribing opioids for pain\u2014United States, 2022","volume":"71","author":"D Dowell","year":"2022","journal-title":"MMWR Recomm Rep"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"e58276","DOI":"10.2196\/58276","article-title":"Clinical decision support to increase emergency department naloxone coprescribing: implementation report","volume":"12","author":"S W Sommers","year":"2024","journal-title":"JMIR Med Inform"},{"key":"ref21","first-page":"3202","article-title":"The minimum viable product (MVP): theory and practice","volume":"50","author":"R Stevenson","year":"2024","journal-title":"J Manage"},{"issue":"10","key":"ref22","doi-asserted-by":"crossref","first-page":"e19676","DOI":"10.2196\/19676","article-title":"Integrating the practical robust implementation and sustainability model with best practices in clinical decision support design: implementation science approach","volume":"22","author":"K E Trinkley","year":"2020","journal-title":"J Med Internet Res"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"e51952","DOI":"10.2196\/51952","article-title":"User-Centered Framework for Implementation of Technology (UFIT): Development of an integrated framework for designing clinical decision support tools packaged with tailored implementation strategies","volume":"26","author":"J Ray","year":"2024","journal-title":"J Med Internet Res"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"e55472","DOI":"10.2196\/55472","article-title":"Applying implementation science to advance electronic health record-driven learning health systems: case studies, challenges, and recommendations","volume":"26","author":"K E Trinkley","year":"2024","journal-title":"J Med Internet Res"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s13012-020-01041-8","article-title":"The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects","volume":"15","author":"J D Smith","year":"2020","journal-title":"Implement Sci"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13012-015-0209-1","article-title":"A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project","volume":"10","author":"B J Powell","year":"2015","journal-title":"Implement Sci"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2716-4479.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:29:28Z","timestamp":1761870568000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2716-4479"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":26,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2025,10,17]]},"published-print":{"date-parts":[[2025,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2716-4479","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10,7]]},"published":{"date-parts":[[2025,10]]}}}