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. 2025 Jan 10;25(1):17.
doi: 10.1186/s12911-025-02850-x.

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

Akanksha Singh  1   2 , Benjamin Schooley  3   2 , John Mobley  4   2 , Patrick Mobley  5   2 , Sydney Lindros  6 , John M Brooks  7   2 , Sarah B Floyd  8   9
Affiliations

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

Akanksha Singh et al. BMC Med Inform Decis Mak. .

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Clinical decision support; Health recommender system; Human factors; Human-centered design; Orthopaedic treatment; Personalized medicine; Proximal humerus fracture.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This final study protocol was reviewed and approved by the Institutional Review Board at Prisma Health. The IRB waived the requirement of signed informed consent, but physician participants were provided an information sheet about the study and were allowed to decline enrollment in the I-C-IT Evaluation. Their verbal agreement to continue with the interview served as consent to participate. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Conflict of interest: None to disclose.

Figures

Fig. 1
Fig. 1
Human-centered design process for health recommender system instance – I-C-IT
Fig. 2a
Fig. 2a
I-C-IT Webapp prototype screen 1
Fig. 2b
Fig. 2b
I-C-IT Webapp prototype screen 2
Fig. 2c
Fig. 2c
I-C-IT Webapp prototype screen 3
Fig. 3
Fig. 3
Results of utility survey
See this image and copyright information in PMC

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