Difference between revisions of "Understanding keys to successful implementation of electronic decision support in rural hospitals: analysis of a pilot study for antimicrobial prescribing"

Revision as of 05:43, 8 November 2015

Background

Clinical Decision Support (CDSS) provide to clinicians an opportunity to have evidence-medicine information at the right moment to enhance decision making. Despite its potential in reducing medical errors, improve clinical outcomes and increase healthcare quality, CDSS are still not widely used by clinicians. Factors such as complexity, lack of adequate training and support as well as increase cost, are constantly cited by clinicians as barriers preventing CDSS implementation.

Introduction

Antimicrobial agents constitute a major portion of hospital pharmacy expenditures, accounting for 20% to 50% of the total budget. Rural hospitals are specially in great disadvantage regarding CDSS implementations because of factors such as insufficient resources, limited clinical information systems as well as limited access to infectious disease physicians providing advice or assistance. Therefore, internet-based decision support tools offer to clinicians an option to provide adequate antimicrobial prescribing advice to those individuals in rural communities lacking access to other complex decision support systems.^[1]

Study design

Pretest/Post-test

Methods

A therapeutic clinical decision support system for the management of infectious diseases called "Antibiotic Assistant" was used during this study. Antibiotic assistant provides patient-specific antimicrobial recommendations based on factors such as co-morbid conditions, recommendations based on demographics characteristics, vitals signs and results of microbiology studies. Five rural hospitals from southwest Idaho were selected; selection was based on various factors such as involvement in a local rural health network as well as geographic proximity to the research team. Participants accessed an internet based platform during the study; this platform was developed and supported by the Centers for Medicare & Medicaid Services. Each prescribing clinician at the different hospitals was asked to introduce patients' data into the Internet-based decision support tool (antibiotic assistant) and to implement the recommendations when making therapeutic and dosing decisions. An antimicrobial management team (AMT) consisting of a nurse, pharmacist and infection control staff was formed in each hospital to prevent the under-utilization the decision support tool as well as to ensure that a clinician was aware of the CDSS recommendations during the first 24 hours of a patient's hospital admission.

Results

Physicians were reluctant to use the internet-based decision support tool because of perceived length of time required for log in and overall system run time. It was also reported that computers were not constantly located in patient care areas. Despite the formation of AMT to obtain CDSS recommendations in a timely fashion and provide that information to clinicians, transfer of information failed to occur in 3 of the participating hospitals.

Conclusion

Cultural factors represented a barrier for the implementation of electronic decision support systems.

References

1. ↑ Understanding Keys to Successful Implementation of Electronic Decision Support in Rural Hospitals: Analysis of a Pilot Study for Antimicrobial Prescribing http://ca3cx5qj7w.search.serialssolutions.com/OpenURL_local?sid=Entrez:PubMed&id=pmid:16280394