Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study
Open accessAbstract
BACKGROUND: The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. METHODS: Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. RESULTS: The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. CONCLUSIONS: These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.
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A key challenge with clinical decision support is knowledge management as guidelines and best practices change over time, as well as governance.
“A key challenge with clinical decision support is knowledge management as guidelines and best practices change over time,40–42 as well as governance.43–45”
From Clinician collaboration to improve clinical decision support: the Clickbusters initiative (2022) · cites this paper as [44]
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“Before each site visit, we asked a local on-site expert to complete a “site profile,” a checklist of types of CDS and questions about CDS management [31].”
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Self-citation
- Authors
- Ash, J. S., Sittig, D. F., Guappone, K. P., Dykstra, R. H., Richardson, J., Wright, A., Carpenter, J., McMullen, C., Shapiro, M., Bunce, A., & Middleton, B.
- Affiliations
- Oregon Health & Science University (US)
- Weill Cornell Medicine (US)
- Brigham and Women's Hospital (US)
- Kaiser Permanente Center for Health Research (US)
- Corresponding author
- Ash, Joan S
- ORCID
- Venue
- BMC Medical Informatics and Decision Making
- Published
- 2012-02-14
- Volume
- 12
- Issue
- 1
- Pages
- 6-6
- ISSN
- 1472-6947 (ISSN-L)
- PMC
- PMC3334687
- OpenAlex
- W2108507313
- Cited by
- 103
- References
- 6
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 8 · 2022: 9 · 2021: 5 · 2020: 6 · 2019: 7 · 2018: 8 · 2017: 9 · 2016: 6 · 2015: 11 · 2014: 9 · 2013: 9 · 2012: 3
- FWCI
- 15.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Informatics and Decision Making (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Agency for Healthcare Research and Quality (HHSA290200810010)
- U.S. Public Health Service (HHSA290200810010)
- U.S. National Library of Medicine (R56LM006942, 563 R56-LM006942, T15LM007088)
- 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 › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- computerized clinical decision support, knowledge management, outpatient clinics, community hospitals, recommended practices, workflow, human-computer interaction, health information technology adoption
- MeSH terms
- Diffusion of Innovation, Female, Health Planning Guidelines, Hospitals, Community, Humans, Inservice Training, Institutional Management Teams, Interprofessional Relations, Male, Research Personnel, Social Support, Systems Analysis, United States, Process Assessment, Health Care, Practice Guidelines as Topic, Decision Support Systems, Clinical, Qualitative Research, Knowledge Management
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