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The anatomy of decision support during inpatient care provider order entry (CPOE): Empirical observations from a decade of CPOE experience at Vanderbilt
Open accessAbstract
The authors describe a pragmatic approach to the introduction of clinical decision support at the point of care, based on a decade of experience in developing and evolving Vanderbilt's inpatient "WizOrder" care provider order entry (CPOE) system. The inpatient care setting provides a unique opportunity to interject CPOE-based decision support features that restructure clinical workflows, deliver focused relevant educational materials, and influence how care is delivered to patients. From their empirical observations, the authors have developed a generic model for decision support within inpatient CPOE systems. They believe that the model's utility extends beyond Vanderbilt, because it is based on characteristics of end-user workflows and on decision support considerations that are common to a variety of inpatient settings and CPOE systems. The specific approach to implementing a given clinical decision support feature within a CPOE system should involve evaluation along three axes: what type of intervention to create (for which the authors describe 4 general categories); when to introduce the intervention into the user's workflow (for which the authors present 7 categories), and how disruptive, during use of the system, the intervention might be to end-users' workflows (for which the authors describe 6 categories). Framing decision support in this manner may help both developers and clinical end-users plan future alterations to their systems when needs for new decision support features arise.
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Metadata
- Authors
- Miller, R. A., Waitman, L. R., Chen, S., & Rosenbloom, S. T.
- Affiliations
- Vanderbilt University Medical Center (US)
- Corresponding author
- Miller, Randolph A.
- Venue
- Journal of Biomedical Informatics
- Publisher
- Elsevier BV
- Published
- 2005-12
- Volume
- 38
- Issue
- 6
- Pages
- 469-485
- ISSN
- 1532-0464 (ISSN-L)
- OpenAlex
- W2098595796
- Cited by
- 144
- References
- 102
- Citations by year
- 2024: 5 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 5 · 2017: 8 · 2016: 11 · 2015: 7 · 2014: 7 · 2013: 13 · 2012: 11
- FWCI
- 18.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Biomedical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Vanderbilt University
- National Institutes of Health (5r01lm007995-06, 5r01lm006226-03)
- School of Medicine, Vanderbilt University
- U.S. National Library of Medicine (K22-LM-08576, R01-LM-007995, K22LM008576, LM06226, R01-LM-06226)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
- Keywords
- clinical decision support, computerized physician order entry, inpatient care, point-of-care intervention, clinical workflow, workflow disruption, clinical teaching
- MeSH terms
- Admitting Department, Hospital, Decision Making, Organizational, Humans, Inpatients, Patient Education as Topic, Personnel, Hospital, Professional-Patient Relations, Tennessee
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