A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success
This is a review Wright, A., Ash, J. S., Erickson, J. L., Wasserman, J., Bunce, A., Stanescu, A., ... & Sittig, D. F. (2013) article, A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success.
In this journal article, the authors discuss how health information technology (HIT) which includes electronic health records (EHRs), computerized provider order entry (CPOE) systems, and clinical decision support (CDS) systems, has increased the quality and effectiveness of health care in the United States. This improvement is partially due to recent US congressional legislation which encourages and guides the adoption of health information technology nationwide. But unfortunately, barriers continue to exist related to utilizing health information technology and clinical decision support systems, several being the absence of skilled workers and technicians, exorbitant implementation costs, and the lack of solid academic research on CDS systems.
The basic purpose of this research study is to highlight the various roles of the professional individuals that are responsible for creating, implementing, maintaining, and evaluating CDS systems. In addition, the authors attempt to describe the various roles and activities that health care professionals play in regards to developing and maintaining CDS systems, especially those that highlight and support their responsibilities as opposed to their professional job titles.
For this study, Linstone's Multiple Perspectives Model was utilized in order to describe the theoretical underpinnings of the authors’ perspectives on clinical decision support systems. This model provided subject selection and data analysis and incorporated the perspectives of clinical end users, CDS developers, and administrators via different meanings about the various concepts of CDS. All of the qualitative dataset was collected between 2007 and 2009 and was approved by several review boards at universities across the nation.
The results were quite complex and exhaustive. Overall, the authors identified 219 various activities that their informants or participants described as being central to utilizing and installing a clinical decision support system at their places of employment, such as hospitals and clinics. The authors then sorted through these activities and came up with 18 that are of major importance. They then ascribed these activities into sections via patterns that were seen across all the study sites related to the role of people in CDS.
As to clinical decision support interventions, there are three specific areas that need to be mentioned concerning the successful implementation CDS--first, all those involved in the process need to be fully trained in order to guarantee proper implementation and the effective use of CDS systems; second, there must be highly knowledgeable individuals on-site who can answer questions and provide and gather feedback for later consultation; and third, early planning is essential, at least six months before going live which would help CDS practitioners to gain an understanding of the functionality of the system before implementation.
- Wright, A., Ash, J. S., Erickson, J. L., Wasserman, J., Bunce, A., Stanescu, A., ... & Sittig, D. F. (2013). A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success. Journal of the American Medical Informatics Association, amiajnl-2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994853/