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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2009

Open Access 01-12-2009 | Research article

Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings

Authors: Madhukar H Trivedi, Ella J Daly, Janet K Kern, Bruce D Grannemann, Prabha Sunderajan, Cynthia A Claassen

Published in: BMC Medical Informatics and Decision Making | Issue 1/2009

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Abstract

Background

Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational support (leadership procedures and resources) for the change and strategies to implement and maintain new systems.

Methods

To examine the feasibility and effectiveness of implementation of a computerized decision support system for depression (CDSS-D) in routine public mental health care in Texas, fifteen study clinicians (thirteen physicians and two advanced nurse practitioners) participated across five sites, accruing over 300 outpatient visits on 168 patients.

Results

Issues regarding computer literacy and hardware/software requirements were identified as initial barriers. Clinicians also reported concerns about negative impact on workflow and the potential need for duplication during the transition from paper to electronic systems of medical record keeping.

Conclusion

The following narrative report based on observations obtained during the initial testing and use of a CDSS-D in clinical settings further emphasizes the importance of taking into account organizational factors when planning implementation of evidence-based guidelines or decision support within a system.
Appendix
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Literature
1.
Woolf SH: Practice guidelines: a new reality in medicine. III. Impact on patient care. Arch Intern Med. 1993, 153 (23): 2646-2655. 10.1001/archinte.153.23.2646.CrossRefPubMed
2.
Kanouse DE, Winkler JD, Kosecoff J: Changing medical practice through technological assessment: An evaluation of the NIH Consensus Development Program. 1989, Santa Monica, CA: Rand
3.
Lomas J, Anderson GM, Domnick-Pierre K, Vayda E, Enkin MW, Hannah WJ: Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989, 321 (19): 1306-1311.CrossRefPubMed
4.
Shojania KG, Grimshaw JM: Evidence-based quality improvement: the state of the science. Health Aff (Millwood). 2005, 24 (1): 138-150. 10.1377/hlthaff.24.1.138.CrossRef
5.
Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA, Cochrane Effective Practice Org Care Review Grp: Getting research findings into practice – Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. Br Med J. 1998, 317 (7156): 465-468.CrossRef
6.
Rush AJ, Trivedi MH: Treating Depression to Remission. Psychiatr Ann. 1995, 25 (12): 704-705.CrossRef
7.
Schulberg HC: Treating depression in primary care practice: applications of research findings. J Fam Pract. 2001, 50 (6): 535-537.PubMed
8.
Katon W, VonKorff M, Lin E, Walker E, Simon GE, Bush T, Robinson P, Russo J: Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995, 273 (3): 1026-1031. 10.1001/jama.273.13.1026.CrossRefPubMed
9.
Lin EH, Katon WJ, VonKorff M, Russo JE, Simon GE, Bush TM, Rutter CM, Walker EA, Ludman E: Relapse of depression in primary care. Rate and clinical predictors [see comment]. Arch Fam Med. 1998, 7 (5): 443-449. 10.1001/archfami.7.5.443.CrossRefPubMed
10.
Getting Evidence into Practice. Eff Health Care. 1999, 5 (1): 1-16.
11.
Solberg LI: Guideline implementation: Why don't we do it?. Am Fam Physician. 2002, 65 (2): 176-182.PubMed
12.
Wensing M, van der Weijden T, Grol R: Implementing guidelines and innovations in general practice: which interventions are effective?. Br J Gen Pract. 1998, 48 (427): 991-997.PubMedPubMedCentral
13.
Cabana MD, Clark N: Challenges in evaluating methods to improve physician practice. J Pediatr. 2003, 143 (4): 413-414. 10.1067/S0022-3476(03)00438-4.CrossRefPubMed
14.
Margolis CZ, Warshawsky SS, Goldman L, Dagan O, Wirtschafter D, Pliskin JS: Computerized algorithms and pediatricians' management of common problems in a community clinic. Acad Med. 1992, 67 (4): 282-284. 10.1097/00001888-199204000-00021.CrossRefPubMed
15.
Mittman BS, Tonesk X, Jacobson PD: Implementing clinical practice guidelines: social influence strategies and practitioner behavior change. QRB Qual Rev Bull. 1992, 18 (12): 413-422.PubMed
16.
Tierney WM: Improving clinical decisions and outcomes with information: a review. Int J Med Inf. 2001, 62 (1): 1-9. 10.1016/S1386-5056(01)00127-7.CrossRef
17.
Deering MJ: Developing the health information infrastructure in the United States. Stud Health Technol Inform. 2002, 80: 121-128.PubMed
18.
Sim I, Gorman P, Greenes RA, Haynes RB, Kaplan B, Lehmann H, Tang PC: Clinical decision support systems for the practice of evidence-based medicine. J Am Med Inform Assoc. 2001, 8 (6): 527-534.CrossRefPubMedPubMedCentral
19.
Dorr D, Bonner LM, Cohen AN, Shoai RS, Perrin R, Chaney E, Young AS: Informatics systems to promote improved care for chronic illness: A literature review. J Am Med Inform Assoc. 2007, 14 (2): 156-163. 10.1197/jamia.M2255.CrossRefPubMedPubMedCentral
20.
Sittig DF, Krall MA, Dykstra RH, Russell A, Chin HL: A Survey of Factors Affecting Clinician Acceptance of Clinical Decision Support. BMC Med Inform Decis Mak. 2006, 6 (1): 6-10.1186/1472-6947-6-6.CrossRefPubMedPubMedCentral
21.
Crismon ML, Trivedi M, Pigott TA, Rush AJ, Hirschfeld RMA, Kahn DA, DeBattista C, Nelson JC, Nierenberg AA, Sackeim HA: The Texas Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Major Depressive Disorder. J Clin Psychiatry. 1999, 60 (3): 142-156.CrossRefPubMed
22.
Miller AL, Chiles JA, Chiles JK, Crismon ML, Rush AJ, Shon SP: The Texas Medication Algorithm Project (TMAP) schizophrenia algorithms. J Clin Psychiatry. 1999, 60 (10): 649-657.CrossRefPubMed
23.
Suppes T, Swann AC, Dennehy EB, Habermacher ED, Mason M, Crismon ML, Toprac MG, Rush AJ, Shon SP, Altshuler KZ: Texas Medication Algorithm Project: Development and feasibility testing of a treatment algorithm for patients with bipolar disorder. J Clin Psychiatry. 2001, 62 (6): 439-447.CrossRefPubMed
24.
Diagnostic and Statistical Manual of Mental Disorders – Text Revision. American Psychiatric Association. 2000, Washington, DC
25.
Chaudhry B: Computerized clinical decision support: will it transform healthcare?. J Gen Intern Med. 2008, 23 (Suppl 1): 85-87. 10.1007/s11606-007-0432-9.CrossRefPubMed
26.
Osheroff JA, Teich JM, Middleton B, Steen EB, Wright A, Detmer DE: A roadmap for national action on clinical decision support. J Am Med Inform Assoc. 2007, 14 (2): 141-145. 10.1197/jamia.M2334.CrossRefPubMedPubMedCentral
Metadata
Title
Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings
Authors
Madhukar H Trivedi
Ella J Daly
Janet K Kern
Bruce D Grannemann
Prabha Sunderajan
Cynthia A Claassen
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2009
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-9-6

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