A study on the views of clinical decision support found tension between clinical users and vendors, as well as a shared belief that national standards could solve many of the problems.
The study, published at BMC Medical Informatics and Decision-making, sought out the views of three groups: clinical stakeholders, CDS content vendors and electronic health record vendors.
All three sides agreed on issues such as the importance of having the appropriate staff, careful knowledge management, fitting user workflow and the need for communication among the groups. However, they differed on issues such as usability, training, metrics and interoperability.
Among the issues:
- People: Clinical organizations need analysts with both technical skills and knowledge of healthcare to customize CDS. Content vendors need clinicians with skills in evidence-based medicine and writing; EHR vendors need physician consultants who help train staff within purchasing organizations to manage CDS and use it.
- Knowledge management: Clinical site staff members often are frustrated that they have to put so much effort into even the most basic CDS.
- Communication: All three groups believe the other groups do not understand what they do.
- Interoperability: Both clinical site and content vendor groups are frustrated that more progress has not been made by EHR vendors on interoperability and use of standard protocols.
- Training: Clinical site employees had mixed feelings about the quality of training they received from vendors. Conversely, the vendor representatives complained that clinical organizations often were too reluctant to pay for training.
- Measurement and metrics: Measurement of the use and effectiveness of CDS is a challenge. One vendor had offered it for free, but few customers used it.
The clinical participants would like to see national standards for interoperability that vendors actually use. Standards would provide a safe, legal environment, vendors say, that would empower them to provide more CDS tools to customers.
Buyers of CDS system need more and better information to make informed purchase decisions, according to an article published in the Journal of the American Medical Informatics Association. The authors said that available information often is too general to be useful, and that there's little evaluation of outcomes.
In addition, a KLAS report found that CDS reference tools still lack the level of integration necessary to provide the strategic direction that providers need.
To learn more:
- check out the research (.pdf)