Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation

Merel M Pannebakker; Katie Mills; Margaret Johnson; Jon D Emery; Fiona M Walter

doi:10.3399/bjgpopen18X101635

Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation

BJGP Open. 2019 Mar 20;3(1):bjgpopen18X101635. doi: 10.3399/bjgpopen18X101635. eCollection 2019 Apr.

Authors

Merel M Pannebakker¹, Katie Mills¹, Margaret Johnson², Jon D Emery^{3

4}, Fiona M Walter^{5

6}

Affiliations

¹ Research Associate, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
² Patient Representative, c/o The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
³ Herman Professor of Primary Care Cancer Research, Department of General Practice and the Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
⁴ Visiting Senior Researcher, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
⁵ Reader in Primary Care Cancer Research, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
⁶ Honorary Associate Professor, Department of General Practice and the Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia.

Abstract

Background: Timely diagnosis of the serious skin cancer melanoma can improve patient outcomes. Clinical guidelines suggest that GPs use checklists, such as the 7-point checklist (7PCL), to assess pigmented lesions. In 2016, the 7PCL was disseminated by EMIS as an electronic clinical decision support (eCDS) tool.

Aim: To understand GP and patient perspectives on the implementation and usefulness of the eCDS.

Design & setting: Semi-structured interviews with GPs and patients were undertaken. The interviews took place in four general practices in the south east of England following consultations using the eCDS for suspicious pigmented lesions.

Method: Data were collected from semi-structured face-to-face interviews with GPs and from telephone interviews with patients. They were recorded and transcribed verbatim. The Consolidated Framework for Implementation Research (CFIR) underpinned the analysis using thematic approaches.

Results: A total of 14 interviews with GPs and 14 interviews with patients were undertaken. Most GPs reported that, as the eCDS was embedded in the medical record, it was useful, easy to use, time-efficient, and could facilitate patient-GP communication. They were less clear that it could meet policy or patient needs to improve early diagnosis, and some felt that it could lead to unnecessary referrals. Few felt that it had been sufficiently implemented at practice level. More felt confident with their own management of moles, and that the eCDS could be most useful for borderline decision-making. No patients were aware that the eCDS had been used during their consultation.

Conclusion: Successful implementation of a new tool, such as eCDS for melanoma, requires GPs to perceive its value and understand how it can best be integrated into clinical practice. Disseminating a tool without such explanations is unlikely to promote its adoption into routine practice.

Keywords: electronic clinical decision support (eCDS); general practice; melanoma; patients; qualitative; skin cancer.

Grants and funding

NIHR-CS-012-030/DH_/Department of Health/United Kingdom