TY - JOUR
T1 - Lessons learned from implementing service-oriented clinical decision support at four sites
T2 - A qualitative study
AU - Wright, Adam
AU - Sittig, Dean F.
AU - Ash, Joan S.
AU - Erickson, Jessica L.
AU - Hickman, Trang T.
AU - Paterno, Marilyn
AU - Gebhardt, Eric
AU - McMullen, Carmit
AU - Tsurikova, Ruslana
AU - Dixon, Brian E.
AU - Fraser, Greg
AU - Simonaitis, Linas
AU - Sonnenberg, Frank A.
AU - Middleton, Blackford
N1 - Funding Information:
This was supported under contract #HHSA290200810010 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Publisher Copyright:
© 2015 Elsevier Ireland Ltd.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - 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.
AB - 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.
KW - Clinical decision support systems
KW - Computerized
KW - Distributed systems
KW - Electronic health records
KW - Medical record systems
KW - Service-oriented architecture
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U2 - 10.1016/j.ijmedinf.2015.08.008
DO - 10.1016/j.ijmedinf.2015.08.008
M3 - Article
C2 - 26343972
AN - SCOPUS:84942551476
SN - 1386-5056
VL - 84
SP - 901
EP - 911
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
IS - 11
M1 - 3233
ER -