The anatomy of decision support during inpatient care provider order entry (CPOE): Empirical observations from a decade of CPOE experience at Vanderbilt
This is an article review of the article entitled The anatomy of decision support during inpatient care provider order entry (CPOE): Empirical observations from a decade of CPOE experience at Vanderbilt (Miller, R.A. et al 2005) 
The authors intended to evaluate CDS Interventions in the inpatient setting, hoping to answer the following questions:
1. where in the CPOE process is it most appropriate to interrupt workflow with an alert?
2. what categories of CDS are appropriate during CPOE
3. what methods for workflow interruption are considered based on end-user tolerance of interruptions?
The system evaluated was Vanderbilt's WizOrder CPOE system. Key considerations for CDS during CPOE were:
- Content - what information to provide
- Timing - at what point in the CPOE process should the intervention or aler occur
- Method - how should the intervention or alert happen - both in terms of degree of interruption and mechanism
Categories of interventions
- Avert incomplete or incorrect orders by ensureing proper parameters and details included
- Patient specific CDS - based on specific pt information
- Optimized clinical care - improved compliance with regulations, etc.
- Real-time, focused education through educational prompts and links to evidence
Critical points at which to implement
- Initial launching of CPOE application
- Selecting CPOE Patient from Census
- Order entry session start
- Selection of individual order
- Selecting details for individual order
- Completing (signing) order
Approaches - "subtle" to "intrusive"
- Incidental - side text, within order entry window
- Incidental link to additional information or evidence
- Interactive - requires minimal user action to continue
- Pop-Up alerts that user must acknowledge
Implementing CDS during CPOE requires a good understanding of the different types of decision support as well as an appreciation for clinicians' workflow and tolerance (or lack of) for being interrupted.
I would just add that the informaticist facilitating the development of CDSS for CPOE should also understand the culture of the medical staff and the tolerance for any interruption at all. As a teaching hospital, Vanderbilt was able to leverage more accepting residents as end users and champions.
- Miller, R. A., Waitman, L. R., Chen, S., & Rosenbloom, S. T. (2005). The anatomy of decision support during inpatient care provider order entry (CPOE): Empirical observations from a decade of CPOE experience at Vanderbilt. Journal of Biomedical Informatics, 38(6), 469-485. doi:http://dx.doi.org/10.1016/j.jbi.2005.08.009 retrieved from http://www.sciencedirect.com.ezproxyhost.library.tmc.edu/science/article/pii/S1532046405001000