Lessons Learned from Implementing Service-Oriented Clinical Decision Support at Four Sites: A Qualitative Study

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dc.contributor.authorWright, Adam
dc.contributor.authorSittig, Dean F.
dc.contributor.authorAsh, Joan S.
dc.contributor.authorErickson, Jessica L.
dc.contributor.authorHickman, Trang T.
dc.contributor.authorPaterno, Marilyn
dc.contributor.authorGebhardt, Eric
dc.contributor.authorMcMullen, Carmit
dc.contributor.authorTsurikova, Ruslana
dc.contributor.authorDixon, Brian E.
dc.contributor.authorFraser, Greg
dc.contributor.authorSimonaitis, Linas
dc.contributor.authorSonnenberg, Frank A.
dc.contributor.authorMiddleton, Blackford
dc.contributor.departmentDepartment of Epidemiology, Richard M. Fairbanks School of Public Healthen_US
dc.date.accessioned2016-04-22T19:41:06Z
dc.date.available2016-04-22T19:41:06Z
dc.date.issued2015-11
dc.description.abstractObjective 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.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationWright, A., Sittig, D. F., Ash, J. S., Erickson, J. L., Hickman, T. T., Paterno, M., … Middleton, B. (2015). Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study. International Journal of Medical Informatics, 84(11), 901–911. http://doi.org/10.1016/j.ijmedinf.2015.08.008en_US
dc.identifier.urihttps://hdl.handle.net/1805/9394
dc.language.isoen_USen_US
dc.publisherElsevieren_US
dc.relation.isversionof10.1016/j.ijmedinf.2015.08.008en_US
dc.relation.journalInternational Journal of Medical Informaticsen_US
dc.rightsPublisher Policyen_US
dc.sourceAuthoren_US
dc.subjectclinical decision support systemsen_US
dc.subjectmedical record systemsen_US
dc.titleLessons Learned from Implementing Service-Oriented Clinical Decision Support at Four Sites: A Qualitative Studyen_US
dc.typeArticleen_US
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