Human-centered design of a health recommender system for orthopaedic shoulder treatment

• Published in: BMC medical informatics and decision making Vol. 25; no. 1; pp. 17 - 12
• Main Authors: Singh, Akanksha, Schooley, Benjamin, Mobley, John, Mobley, Patrick, Lindros, Sydney, Brooks, John M., Floyd, Sarah B.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.01.2025; BioMed Central; BMC
• Subjects: Clinical decision support; Data visualization; Decision making; Decision Making, Shared; Decision support systems; Decision Support Systems, Clinical - standards; Design analysis; Design standards; Electronic Health Records; Electronic medical records; Ethnography; Fractures; Health recommender system; Health services; Human factors; Human-centered design; Humans; Informatics; Information processing; Medical informatics; Medical personnel; Orthopaedic treatment; Orthopedics; Patients; Personalized medicine; Physicians; Prototypes; Recommender systems; Researchers; Scientific visualization; Shoulder surgery; Surgeons; Surgery; Surgery, Experimental; Surgical outcomes; Surgical research; Systems design; Technology application; Usability; User-Centered Design; United States; Human-centered design; Health recommender system; Human factors; Orthopaedic treatment; Proximal humerus fracture; Clinical decision support; Personalized medicine
• ISSN: 1472-6947; 1472-6947
• DOI: 10.1186/s12911-025-02850-x

Rich data on diverse patients and their treatments and outcomes within Electronic Health Record (EHR) systems can be used to generate real world evidence. A health recommender system (HRS) framework can be applied to a decision support system application to generate data summaries for similar patients during the clinical encounter to assist physicians and patients in making evidence-based shared treatment decisions. A human-centered design (HCD) process was used to develop a HRS for treatment decision support in orthopaedic medicine, the Informatics Consult for Individualized Treatment (I-C-IT). We also evaluate the usability and utility of the system from the physician's perspective, focusing on elements of utility and shared decision-making in orthopaedic medicine. The HCD process for I-C-IT included 6 steps across three phases of analysis, design, and evaluation. A team of health informatics and comparative effectiveness researchers directly engaged with orthopaedic surgeon subject matter experts in a collaborative I-C-IT prototype design process. Ten orthopaedic surgeons participated in a mixed methods evaluation of the I-C-IT prototype that was produced. The HCD process resulted in a prototype system, I-C-IT, with 14 data visualization elements and a set of design principles crucial for HRS for decision support. The overall standard system usability scale (SUS) score for the I-C-IT Webapp prototype was 88.75 indicating high usability. In addition, utility questions addressing shared decision-making found that 90% of orthopaedic surgeon respondents either strongly agreed or agreed that I-C-IT would help them make data informed decisions with their patients. The HCD process produced an HRS prototype that is capable of supporting orthopaedic surgeons and patients in their information needs during clinical encounters. Future research should focus on refining I-C-IT by incorporating patient feedback in future iterative cycles of system design and evaluation.