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

International Journal of Medical Informatics
Adam WrightBlackford Middleton

Abstract

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. 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. 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. Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decis...Continue Reading

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Citations

Jul 13, 2016·Journal of Biomedical Informatics·Luis Marco-RuizJ Gustav Bellika
Oct 19, 2017·Journal of the American Medical Informatics Association : JAMIA·Adam WrightDean F Sittig
Jan 12, 2019·Annual Review of Public Health·Lawrence A PalinkasAlison B Hamilton
Dec 22, 2017·BMJ Quality & Safety·Cecilia Vindrola-Padros, Bruno Vindrola-Padros
Aug 3, 2019·Journal of the American Medical Informatics Association : JAMIA·David RubinsAdam Landman
Nov 10, 2020·International Journal of Clinical Pharmacy·Fahad AlshahraniAnthony R Cox
Dec 7, 2021·BMC Medical Research Methodology·Georgia B BlackNaomi J Fulop

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