Browsing by Subject "clinical decision support systems"

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    Lessons Learned from Implementing Service-Oriented Clinical Decision Support at Four Sites: A Qualitative Study
    (Elsevier, 2015-11) Wright, Adam; Sittig, Dean F.; Ash, Joan S.; Erickson, Jessica L.; Hickman, Trang T.; Paterno, Marilyn; Gebhardt, Eric; McMullen, Carmit; Tsurikova, Ruslana; Dixon, Brian E.; Fraser, Greg; Simonaitis, Linas; Sonnenberg, Frank A.; Middleton, Blackford; Department of Epidemiology, Richard M. Fairbanks School of Public Health
    Objective To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Methods Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. Results We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. Discussion Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. Conclusion The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services.
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    When Informationists Get Involved: The CHICA-GIS Project
    (http://escholarship.umassmed.edu/jeslib/vol2/iss1/10/, 2013-05-02) Whipple, Elizabeth C.; Odell, Jere D.; Ralston, Rick K.; Liu, Gilbert C.
    Child Health Improvement through Computer Automation (CHICA) is a computer decision support system (CDSS) that interfaces with existing electronic medical record systems (EMRS) and delivers "just-in-time" patientrelevant guidelines to physicians during the clinical encounter and accurately captures structured data from all who interact with the system. “Delivering Geospatial Intelligence to Health Care Professionals (CHICAGIS)”(1R01LM010923-01) expands the medical application of Geographic Information Systems (GIS) by integrating a geographic information system with CHICA. To provide knowledge management support for CHICA-GIS, three informationists at the Indiana University School of Medicine were awarded a supplement from the National Library Medicine. The informationists will enhance CHICA-GIS by: improving the accuracy and accessibility of information, managing and mapping the knowledge which undergirds the CHICA-GIS decision support tool, supporting community engagement and consumer health information outreach, and facilitating the dissemination of new CHICA-GIS research results and services.