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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2012

Open Access 01-12-2012 | Research article

Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

Authors: Joan S Ash, Dean F Sittig, Kenneth P Guappone, Richard H Dykstra, Joshua Richardson, Adam Wright, James Carpenter, Carmit McMullen, Michael Shapiro, Arwen Bunce, Blackford Middleton

Published in: BMC Medical Informatics and Decision Making | Issue 1/2012

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Abstract

Background

The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S.

Methods

Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices.

Results

The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction.

Conclusions

These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.
Appendix
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Literature
1.
Hunt DL, Haynes RB, Hanna SE, Smith K: Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998, 280 (15): 1339-46. 10.1001/jama.280.15.1339.CrossRefPubMed
2.
Devine EB, Hansen RN, Wilson-Norton JL, Lawless NM, Fisk AW, Blough DK, Martin DP, Sullivan SD: The impact of computerized provider order entry on medication errors in a multispecialty group practice. J Am Med Inform Assoc. 2010, 17: 78-84. 10.1197/jamia.M3285.CrossRefPubMedPubMedCentral
3.
Kawamoto K, Houlihan CA, Balas EA, Lobach DF: Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 330 (7494): 765-
4.
Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005, 293 (10): 1223-38. 10.1001/jama.293.10.1223.CrossRefPubMed
5.
Kaushal R, Jha AK, Franz C, Glaser J, Shetty KD, Jaggi T, Middleton B, Kuperman GJ, Khorasani R, Tanasijevic M, Bates DW: Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006, 13 (3): 261-6. 10.1197/jamia.M1984.CrossRefPubMedPubMedCentral
6.
Bates DW, Kuperman GJ, Wang S, Ghandi T, Kittler A, Volk L, Spurr C, Khorasani R, Tanasijevic M, Middleton B: Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003, 10 (6): 523-30. 10.1197/jamia.M1370.CrossRefPubMedPubMedCentral
7.
Blumenthal D: Stimulating the adoption of health information technology. N Engl J Med. 2009, 360 (15): 1477-1479. 10.1056/NEJMp0901592.CrossRefPubMed
8.
Ash JS, Gorman PN, Seshadri V, Hersh WR: Computerized physician order entry in U.S. hospitals: results of a 2002 survey. J Am Med Inform Assoc. 2004, 11 (2): 95-9.CrossRefPubMedPubMedCentral
9.
Jha AK, DesRoches CD, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D: Use of electronic health records in U.S. hospitals. N Engl J Med. 2009, 360 (16): 1628-38. 10.1056/NEJMsa0900592.CrossRefPubMed
10.
11.
DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, Kaushal R, Levy DE, Rosenbaum S, Shields A, Blumenthal D: Electronic health records in ambulatory care--a national survey of physicians. N Engl J Med. 2008, 359 (1): 50-60. 10.1056/NEJMsa0802005.CrossRefPubMed
12.
Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG: Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Int Med. 2006, 144 (10): 742-52.CrossRefPubMed
13.
Souza NM, Sebaldt RJ, Mackay JA, Prorok JC, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB: Computerized clinical decision support for primary preventive care: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implem Sci. 2011, 6: 87-10.1186/1748-5908-6-87.CrossRef
14.
Hemens BJ, Holbrook A, Tonkin M, Mackay JA, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB: Computerized clinical decision support for drug prescribing and management: A decision-maker-researcher partnership systematic review. Implem Sci. 2011, 6: 89-10.1186/1748-5908-6-89.CrossRef
15.
Sohota N, Lloyd R, Ramakrishna A, Mackay JA, Prorok Jc, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB: Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implem Sci. 2011, 6: 91-10.1186/1748-5908-6-91.CrossRef
16.
Roshanov PS, Misra S, Gerstein H, Garg AX, Sebaldt RJ, Mackay JA, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB: Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review. Implem Sci. 2011, 6: 92-10.1186/1748-5908-6-92.CrossRef
17.
Stead WW, Linn HS: Computational technology for effective health care: immediate steps and strategic directions. 2009, Washington, D.C.: The National Academies Press
18.
Campbell E, Sittig DF, Ash JS, Guappone K, Dykstra R: Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006, 13 (5): 547-556. 10.1197/jamia.M2042.CrossRefPubMedPubMedCentral
19.
Campbell E, Guappone KP, Sittig DF, Dykstra RH, Ash JS: Computerized provider order entry adoption: implications for clinical workflow. J Gen Int Med. 2009, 24 (1): 21-6. 10.1007/s11606-008-0857-9.CrossRef
20.
Karsh B-T: Clinical practice improvement and redesign: how change in workflow can be supported by clinical decision support. 2009, AHRQ Publication No. 09-0054-EF. Rockville, MD, Agency for Healthcare Research and Quality
21.
Berner ES: Clinical decision support systems: state of the art. 2009, AHRQ Publication No. 09-0060-EF. Rockville, MD: Agency for Healthcare Research and Quality
22.
Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson S: Computerized clinical decision support for prescribing: provision does not guarantee uptake. J Am Med Inform Assoc. 2010, 17: 25-33. 10.1197/jamia.M3170.CrossRefPubMedPubMedCentral
23.
Ash JS, Gorman PN, Lavelle M, Lyman J: Multiple perspectives on physician order entry. AMIA Proc. 2000, 26-30.
24.
Linstone HA: Decision making for technology executives: using multiple perspectives to improve performance. 1999, Boston, MA, Artech House
25.
Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH: The extent and important of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2007, 14 (4): 415-23. 10.1197/jamia.M2373.CrossRefPubMedPubMedCentral
26.
McMullen CK, Ash JS, Sittig DF, Bunce A, Guappone K, Dykstra R, Carpenter J, Richardson J, Wright A: Rapid assessment of clinical information systems in the healthcare setting: An efficient method for time-pressed evaluation. Meth Inform Med. 2011, 50 (4): 299-307.CrossRefPubMed
27.
Middleton B: The Clinical Decision Support Consortium. Stud Health Technol Inform. 2009, 150: 26-30.PubMed
28.
Beebe J: Rapid assessment process: an introduction. 2001, Walnut Creek, CA, AltaMira Press
29.
Handwerker WP: Quick ethnography. 2001, Walnut Creek, CA, AltaMira Press
30.
Trotter RT, Needle RH, Goosby E, Bates C, Singer M: A methodological model for rapid assessment, response, and evaluation: the RARE program in public health. Field Methods. 2001, 13: 137-59. 10.1177/1525822X0101300202.CrossRef
31.
Sittig DF, Wright A, Simonaitis L, Carpenter JD, Allen GO, Doebbeling BN, Sirajuddin AM, Ash JS, Middleton B: The state of the art in clinical knowledge management: an inventory of tools and techniques. Int J Med Inform. 2010, 79: 44-57. 10.1016/j.ijmedinf.2009.09.003.CrossRefPubMed
32.
Spradley JP: Participant observation. 1980, New York, NY, Holt, Rinehart and Winston
33.
Ash JS, Stavri PZ, Kuperman GJ: A consensus statement on considerations for a successful CPOE implementation. Journal of the American Medical Informatics Association. 2003, 10 (3): 229-234. 10.1197/jamia.M1204.CrossRefPubMedPubMedCentral
34.
Doing qualitative research. Edited by: Crabtree BF, Miller WL. 1999, Thousand Oaks, CA, Sage, 2
35.
Ash JS, Stavri PZ, Dykstra R, Fournier L: Implementing computerized physician order entry: the importance of special people. Int J Med Inform. 2003, 69: 235-250. 10.1016/S1386-5056(02)00107-7.CrossRefPubMed
36.
Miller RA, Waitman LR, Chen S, Rosenbloom ST: The anatomy of decision support during inpatient care provider order entry (CPOE): empirical observations from a decade of CPOE experiences at Vanderbilt. J Biomed Inform. 2006, 38 (6): 469-85.CrossRef
37.
Lorenzi NM, Novak LL, Weiss JB, Gadd CS, Unertl KM: Crossing the implementation chasm: a proposal for bold action. J Am Med Inform Assoc. 2008, 15 (3): 290-6. 10.1197/jamia.M2583.CrossRefPubMedPubMedCentral
38.
39.
Osheroff JA, Pifer EA, Teich JM, Sittig DF, Jenders RA: Improving outcomes with clinical decision support: an implementer's guide. 2005, Chicago, IL, HIMSS
40.
Saleem JJ, Patterson ES, Militello L, Render ML, Orshansky G, Asch SM: Exploring barriers and facilitators to the use of computerized clinical reminders. J Am Med Inform Assoc. 2005, 12 (4): 438-47. 10.1197/jamia.M1777.CrossRefPubMedPubMedCentral
41.
Tamblyn R, Huang A, Taylor L, Kawasumi y, Bartlett G, Grad R, Jacques A, Dawes M, Abrahamowicz M, Perreault R, Winslade N, Poissant L, Pinsonneault A: A randomized trial of the effectiveness of on-demand versus computer-triggered drug decision support in primary care. J Am Med Inform Assoc. 2008, 15 (4): 430-8. 10.1197/jamia.M2606.CrossRefPubMedPubMedCentral
42.
Ash JS, Sittig DF, Wright A, McMullen C, Shapiro M, Bunce A, Middleton B: Clinical decision support in small community practice settings: a case study. Journal of the American Medical Informatics Association. 2011, 18 (6): 879-882. 10.1136/amiajnl-2010-000013.CrossRefPubMedPubMedCentral
43.
Berner ES, Kasiraman RK, Yu F, Ray MN: Data quality in the outpatient setting: impact on clinical decision support systems. AMIA Proc. 2005, 41-5.
44.
Wright A, Goldberg H, Hongsmeier T, Middleton B: A description and functional anatomy of ruled-base decision support content at a large integrated delivery network. J Am Med Inform Assoc. 2007, 14 (4): 489-96. 10.1197/jamia.M2364.CrossRefPubMedPubMedCentral
45.
46.
Agar M: Language shock: understanding the culture of conversation. 1995, New York, N.Y., William Morrow
Metadata
Title
Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study
Authors
Joan S Ash
Dean F Sittig
Kenneth P Guappone
Richard H Dykstra
Joshua Richardson
Adam Wright
James Carpenter
Carmit McMullen
Michael Shapiro
Arwen Bunce
Blackford Middleton
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2012
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-12-6

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