Difference between revisions of "EBMeDS Study Group. What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians"
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What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians | What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians | ||
Helena Varonen, Tiina Kortteisto and Minna Kaila for the EBMeDS Study Group | Helena Varonen, Tiina Kortteisto and Minna Kaila for the EBMeDS Study Group | ||
| − | Question: The Finnish Medical Society Duodecim, made up of approximately 90% of Finland’s physicians, has chartered a national decision support project committee. The committee has been charged with developing, implementing, and evaluating the comprehensive decision support system that will utilize national guidelines and be linked to any electronic health record. The project is named Evidence Based Medicine electronic Decision Support (EBMeDS) and the committee authored this paper. | + | |
| + | '''Question and Background:''' The Finnish Medical Society Duodecim, made up of approximately 90% of Finland’s physicians, has chartered a national decision support project committee. The committee has been charged with developing, implementing, and evaluating the comprehensive decision support system that will utilize national guidelines and be linked to any electronic health record. The project is named Evidence Based Medicine electronic Decision Support (EBMeDS) and the committee authored this paper. | ||
Methods: Before beginning the CDSS design, Varonen et al conducted a qualitative study to evaluate the usability and acceptability of a decision support system among physicians. Qualitative methods were preferred to quantitative to better capture the richness of participants’ responses. In 2005 the authors conducted seven focus groups of primary and secondary physicians from large, small and rural towns. The 39 participants answered questions posed from a semi-structured interview guide. (It is noteworthy there is a plan to interview physicians during and after the design is completed.) | Methods: Before beginning the CDSS design, Varonen et al conducted a qualitative study to evaluate the usability and acceptability of a decision support system among physicians. Qualitative methods were preferred to quantitative to better capture the richness of participants’ responses. In 2005 the authors conducted seven focus groups of primary and secondary physicians from large, small and rural towns. The 39 participants answered questions posed from a semi-structured interview guide. (It is noteworthy there is a plan to interview physicians during and after the design is completed.) | ||
| − | Results: The authors analyzed the material, and then coded themes which were consolidated into three categories. Below is a list of the three categories, theme examples and a representative quote, | + | '''Results:''' The authors analyzed the material, and then coded themes which were consolidated into three categories. Below is a list of the three categories, theme examples and a representative quote, |
| − | 1. Use of CDSS (sample from a list of 30) | + | <nowiki>1. Use of CDSS (sample from a list of 30) |
| − | Theme examples | + | Theme examples |
| − | • Show diagnostic criteria | + | • Show diagnostic criteria |
• Monitor chronic disease disorders | • Monitor chronic disease disorders | ||
• Reminders of follow-up visits needed | • Reminders of follow-up visits needed | ||
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• Simplicity and ease of use | • Simplicity and ease of use | ||
• Resistance towards change | • Resistance towards change | ||
| − | Representative quote: “”All this is new, sounds like extra work….” | + | Representative quote: “”All this is new, sounds like extra work….”</nowiki> |
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| + | '''Conclusion:''' Varonen et al concluded physicians have “rather positive attitudes” about a future CDSS implementation. However, the physicians expect to maintain some control of the system. In addition, the system should be flexible, reliable and tailorable. Given Finnish physicians have the world’s highest review rate of Cochrane guidelines and National guidelines are well used, the way for CDSS has been paved. | ||
| − | + | '''Comments:''' This study offers the Finnish perspective on physicians' preferences around Clinical Decision Support. It is interesting to note the conclusions are similiar to the p;references of American physicians. | |
Revision as of 17:45, 24 October 2008
What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians Helena Varonen, Tiina Kortteisto and Minna Kaila for the EBMeDS Study Group
Question and Background: The Finnish Medical Society Duodecim, made up of approximately 90% of Finland’s physicians, has chartered a national decision support project committee. The committee has been charged with developing, implementing, and evaluating the comprehensive decision support system that will utilize national guidelines and be linked to any electronic health record. The project is named Evidence Based Medicine electronic Decision Support (EBMeDS) and the committee authored this paper. Methods: Before beginning the CDSS design, Varonen et al conducted a qualitative study to evaluate the usability and acceptability of a decision support system among physicians. Qualitative methods were preferred to quantitative to better capture the richness of participants’ responses. In 2005 the authors conducted seven focus groups of primary and secondary physicians from large, small and rural towns. The 39 participants answered questions posed from a semi-structured interview guide. (It is noteworthy there is a plan to interview physicians during and after the design is completed.)
Results: The authors analyzed the material, and then coded themes which were consolidated into three categories. Below is a list of the three categories, theme examples and a representative quote,
1. Use of CDSS (sample from a list of 30) Theme examples • Show diagnostic criteria • Monitor chronic disease disorders • Reminders of follow-up visits needed • Statistics of practice Representative quote: “It would be good to have reminders of things that you need to check yearly in diabetic patients. You may think you just checked the reflexes and so on but it may be long ago…” 2. Advantages and disadvantages of CDSS Theme examples • Potential harm to doctor-patient relationship, especially communication • Threats to clinician’s autonomy • Potential extra workload due to excessive reminders • Can educate physicians Representative quote: ”As a mater of fact, it [CDSS] teaches you. If you get a reminder saying that you cannot prescribe this neurolept to a demented patient, you’ll learn it. My opinion is that it improves clinical skills, not ruins them.” 3. Facilitators and barriers of CDSS Theme examples • Previous problems with dysfunctional computer systems • Flexibility of the system; tailored topics and possibility to switch off • Reliability; reliable knowledge-base and that trusted peers are developing the system • Simplicity and ease of use • Resistance towards change Representative quote: “”All this is new, sounds like extra work….”
Conclusion: Varonen et al concluded physicians have “rather positive attitudes” about a future CDSS implementation. However, the physicians expect to maintain some control of the system. In addition, the system should be flexible, reliable and tailorable. Given Finnish physicians have the world’s highest review rate of Cochrane guidelines and National guidelines are well used, the way for CDSS has been paved.
Comments: This study offers the Finnish perspective on physicians' preferences around Clinical Decision Support. It is interesting to note the conclusions are similiar to the p;references of American physicians.
