Clinical decision support: What steps are a must for success?

Hospitals using clinical decision support technology would be more likely to achieve success in their efforts if they employed a team-based approach consisting of 18 separate activities, according to research published online this week in the Journal of the American Medical Informatics Association.

For the study, 12 researchers from all across the U.S. conducted "ethnographic observations" at seven different sites, all of which had successfully deployed CDS tools. They identified the following 18 common activities among the sites, divided into four categories:

Fostering relationships across the organization:

  • Training and support
  • Visibility/presence on the floor
  • Liaising between people
  • Administration and leadership
  • Project management
  • Cheerleading/buy-in/sponsorship
  • Preparing for CDS implementation

Assembling the system:

  • Providing technical support
  • CDS content development
  • Purchasing products from vendors
  • Knowledge management
  • System integration

Using CDS to achieve the organizations goals:

  • Reporting
  • Requirements-gathering
  • Monitoring CDS
  • Linking CDS to goals
  • Managing data

Participation in external policy and standards activities

The researchers said that performance of the activities "varied significantly" from hospital to hospital, with each facility organizing the activities differently. "In particular, we found that the way the activities were organized into roles and assigned to people or teams differed widely," they said. "For example, some smaller sites had only one person conducting all 18 activities, while other sites had entire departments dedicated to one or more of those activities."

Specific recommendations for each of the activities were shared by the researchers, as well. For instance, with regard to "training and support," they suggested creating a training curriculum and communication package for each new CDS intervention developed. They also said to provide such training both before and after each new intervention goes live. "Don't just silently turn on an intervention and hope it will work," they said.

A report published by Orem, Utah-based research firm KLAS in August found that clinical decision support tools had a moderate to significant impact on clinical outcomes for a majority of providers surveyed. Out of 140 providers, 48 percent said that the tools were "significant" to the outcomes of patients, while 31 percent said CDS surveillance had a "moderate" impact their patients. Five percent said the tools had no impact at all.

To learn more:
- read the full study in JAMIA


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