Integrating PRISM with User-centered Design (PRISM+UCD): Designing clinical decision support for safe opioid prescribing

Background :Balancing safe opioid prescribing with effective pain management is essential to addressing the opioid crisis. Increasing clinician adoption of evidence-based safety practices is a public health priority. This project presents a practical, adaptable approach to developing electronic health record (EHR)-embedded clinical decision support (CDS) strategies that promote uptake of opioid safety measures recommended by the Centers for Disease Control and Prevention (CDC). The goal was to design implementation strategies that enhance guideline-concordant opioid prescribing, including a suite of EHR-integrated CDS tools. Methods : Guided by the Practical, Robust Implementation and Sustainability Model (PRISM) and informed by implementation science and user-centered design (UCD), we used an iterative, multi-level engagement process. PRISM served as the theoretical framework for integrating collaborator input and user testing throughout the development cycle. Activities included discovery, design, prototyping, and usability testing. Collaborators included executive decision-makers, informatics leaders, frontline clinicians across diverse settings, representatives from the CDC and National Institute on Drug Abuse, and patients. These methods informed the selection of opioid safety measures, design themes, and workflow considerations, resulting in implementation-ready CDS prototypes. Results : The discovery phase identified a naloxone prescribing alert as a strong candidate for redesign, aligning with CDC guidelines and relevant across all four PRISM domains. The final redesign received mean ratings of 4.0 and 4.2 out of 5 on the Acceptability of Intervention Measure (AIM) from inpatient and outpatient clinicians, respectively.