Integrating Clinical Decision Support Into Workflow—Final Report – AHRQ – September 2011

Posted on October 4, 2011. Filed under: Evidence Based Practice, Health Informatics, Knowledge Translation | Tags: , |

Integrating Clinical Decision Support Into Workflow—Final Report – AHRQ – September 2011

Doebbeling BN, Saleem J, Haggstrom D, et al. Integrating Clinical Decision Support Into Workflow—Final Report. (Prepared by Indiana University, Regenstrief Institute under Contract No. HSA290200600013-3.) AHRQ Publication No. 11-0076-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2011.

Agency for Healthcare Research and Quality – AHRQ Publication No. 11-0076-EF

“Structured Abstract

Purpose: The aims were to (1) identify barriers and facilitators related to integration of clinical decision support (CDS) into workflow and (2) develop and test CDS design alternatives.

Scope: To better understand CDS integration, we studied its use in practice, focusing on CDS for colorectal cancer (CRC) screening and followup. Phase 1 involved outpatient clinics of four different systems—120 clinic staff and providers and 118 patients were observed. In Phase 2, prototyped design enhancements to the Veterans Administration’s CRC screening reminder were compared against its current reminder in a simulation experiment. Twelve providers participated.

Methods: Phase 1 was a qualitative project, using key informant interviews, direct observation, opportunistic interviews, and focus groups. All data were analyzed using a coding template, based on the sociotechnical systems theory, which was modified as coding proceeded and themes emerged. Phase 2 consisted of rapid prototyping of CDS design alternatives based on Phase 1 findings and a simulation experiment to test these design changes in a within-subject comparison.

Results: Very different CDS types existed across sites, yet there are common barriers: (1) lack of coordination of “outside” results and between primary and specialty care; (2) suboptimal data organization and presentation; (3) needed provider and patient education; (4) needed interface flexibility; (5) needed technological enhancements; (6) unclear role assignments; (7) organizational issues; and (8) disconnect with quality reporting. Design enhancements positively
impacted usability and workflow integration but not workload.

Conclusions: Effective CDS design and integration requires: (1) organizational and workflow integration; (2) integrating outside results; (3) improving data organization and presentation in a flexible interface; and (4) providing just-in time education, cognitive support, and quality reporting.”

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