User recruitment. After piloting, the VISN 21 HCV dashboard was introduced during monthly pharmacy meetings and clinical telehealth encounters with providers. Feedback was solicited during the presentations and through postdevelopment surveys. In particular, providers requested spreadsheet-friendly formatting, additional informational fields consisting of mental health and substance abuse diagnoses, and identification of all patients with HCV regardless
of disease severity. A key element of dashboard refinement includes enhancing usability by solicitation of user feedback with subsequent tailoring of the user interface. 12
Challenges
Many challenges exist in clinical dashboard development, expansion, and implementation including data integrity, workflow, and work culture. Data elements are often variable within a single facility, and this variation increases when identifying the same elements across facilities. For example, a laboratory test name (eg, “serum creatinine”) may exist with 2 to 3 different labels (eg, “creat,” “SCr,” “serum Cr”) within a single facility. As the variation increases, potential for inappropriate laboratory tests may be increased. Specialty clinic names also vary within and between facilities.
Local nomenclature for HCV clinic names may include “liver,” “infectious disease,” “hepatitis c,” or some variation, making it crucial for the dashboard developer to work closely with clinical staff to accurately matchspecialty clinic names being pulled from the data warehouse. Given the complexities of naming nomenclature within VA data, dashboard development requires a substantial investment of code customization and validation.
Ongoing dashboard maintenance is another important challenge due to the need for staff trained in SQL coding and familiarity with VA data warehouse architecture. Consequently, until the VHA dedicates resources to maintain such dashboards, only VISNs with existing technical knowledge and staffing will benefit from dashboards.
Usability, typically defined as “…effectiveness, efficiency and satisfaction with which the intended users can achieve their tasks in the intended context of product use,” is an additional consideration as the HCV clinical dashboard disseminates nationally. 13 Standard clinic workflow is not always conducive to the use of dashboards. VHA providers use the Computerized Patient Record System (CPRS) to review and document patient notes. However, accessing the HCV dashboard involves a site hosted outside of CPRS, thereby requiring the user to take several extra steps. These and other usability factors will need to be considered as the dashboard disseminates more widely.
Finally, data describing the effectiveness of clinical dashboards is very limited. VISN 21 is tracking the number of users accessing the dashboard. However, further study is needed to determine if clinical dashboards improve patient access and quality of care as well as factors to enhance usability
Conclusion
Clinical dashboards have the ability to transform each clinical provider into a population health manager who can readily identify patients most in need of care within their facility catchment area and beyond. As HCV dashboard development and implementation grows across the VHA, there is a need to pair clinical and technological advancements with greater patient outreach and shared best practices. Understanding the factors that tie improved quality of care with usability as well as investment in dashboard development and related efforts will likely keep the VHA in the forefront of chronic care delivery.