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Appl Clin Inform 2024; 15(03): 556-568
DOI: 10.1055/a-2297-9129
Research Article

User-Centered Design and Implementation of an Interoperable FHIR Application for Pediatric Pneumonia Prognostication in a Randomized Trial

Robert W. Turer
1   Department of Emergency Medicine and Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
,
Stephen C. Gradwohl
2   Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Justine Stassun
2   Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Jakobi Johnson
2   Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Jason M. Slagle
4   Department of Anesthesiology and Institute of Medicine and Public Health, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Carrie Reale
4   Department of Anesthesiology and Institute of Medicine and Public Health, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Russ Beebe
4   Department of Anesthesiology and Institute of Medicine and Public Health, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Hui Nian
5   Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Yuwei Zhu
5   Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Daniel Albert
6   HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Timothy Coffman
6   HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Hala Alaw
6   HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Tom Wilson
6   HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Shari Just
6   HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Perry Peguillan
6   HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Heather Freeman
6   HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Donald H. Arnold
2   Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Judith M. Martin
7   Department of Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Srinivasan Suresh
7   Department of Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Scott Coglio
8   Enterprise Development Services, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Ryan Hixon
8   Enterprise Development Services, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Krow Ampofo
3   Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, United States
,
Andrew T. Pavia
3   Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, United States
,
Matthew B. Weinger
4   Department of Anesthesiology and Institute of Medicine and Public Health, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
9   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Derek J. Williams
2   Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Asli O. Weitkamp
9   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations Funding This work was supported by the National Institute of Health National Institute of Allergy and Infectious Diseases (grant R01AI125642).
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Abstract

Objectives To support a pragmatic, electronic health record (EHR)-based randomized controlled trial, we applied user-centered design (UCD) principles, evidence-based risk communication strategies, and interoperable software architecture to design, test, and deploy a prognostic tool for children in emergency departments (EDs) with pneumonia.

Methods Risk for severe in-hospital outcomes was estimated using a validated ordinal logistic regression model to classify pneumonia severity. To render the results usable for ED clinicians, we created an integrated SMART on Fast Healthcare Interoperability Resources (FHIR) web application built for interoperable use in two pediatric EDs using different EHR vendors: Epic and Cerner. We followed a UCD framework, including problem analysis and user research, conceptual design and early prototyping, user interface development, formative evaluation, and postdeployment summative evaluation.

Results Problem analysis and user research from 39 clinicians and nurses revealed user preferences for risk aversion, accessibility, and timing of risk communication. Early prototyping and iterative design incorporated evidence-based design principles, including numeracy, risk framing, and best-practice visualization techniques. After rigorous unit and end-to-end testing, the application was successfully deployed in both EDs, which facilitated enrollment, randomization, model visualization, data capture, and reporting for trial purposes.

Conclusion The successful implementation of a custom application for pneumonia prognosis and clinical trial support in two health systems on different EHRs demonstrates the importance of UCD, adherence to modern clinical data standards, and rigorous testing. Key lessons included the need for understanding users' real-world needs, regular knowledge management, application maintenance, and the recognition that FHIR applications require careful configuration for interoperability.

Keywords

FHIR - user-centered design - electronic health record - interoperability - research informatics

Protection of Human and Animal Subjects

This study was approved by the Vanderbilt University Medical Center Institutional Review Board.


Note

Code related to this project is unable to be shared publicly due to security concerns. Investigators interested in generating similar applications may contact the authorship team to discuss technical details.


Supplementary Material



Publication History

Received: 21 November 2023

Accepted: 27 March 2024

Accepted Manuscript online:
02 April 2024

Article published online:
17 July 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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