Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study

Adam Wright, Dean F. Sittig, Joan S. Ash, Jessica L. Erickson, Trang T. Hickman, Marilyn Paterno, Eric Gebhardt, Carmit McMullen, Ruslana Tsurikova, Brian E. Dixon, Greg Fraser, Linas Simonaitis, Frank A. Sonnenberg, Blackford Middleton

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


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.

Original languageEnglish (US)
Article number3233
Pages (from-to)901-911
Number of pages11
JournalInternational Journal of Medical Informatics
Issue number11
StatePublished - Nov 1 2015
Externally publishedYes


  • Clinical decision support systems
  • Computerized
  • Distributed systems
  • Electronic health records
  • Medical record systems
  • Service-oriented architecture

ASJC Scopus subject areas

  • Health Informatics


Dive into the research topics of 'Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study'. Together they form a unique fingerprint.

Cite this