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1.
Stud Health Technol Inform ; 245: 1385, 2017.
Article in English | MEDLINE | ID: mdl-29295464

ABSTRACT

Clinical decision support systems, when used effectively, can improve the quality of care. However, such systems can malfunction, and these malfunctions can be difficult to detect. In this poster, we describe four methods of detecting and resolving issues with clinical decision support: 1) statistical anomaly detection, 2) visual analytics and dashboards, 3) user feedback analysis, 4) taxonomization of failure modes/effects.


Subject(s)
Decision Support Systems, Clinical , Electronic Health Records , Humans
2.
Int J Med Inform ; 84(11): 901-11, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26343972

ABSTRACT

OBJECTIVE: To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. METHODS: Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. RESULTS: We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. DISCUSSION: Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. CONCLUSION: The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services.


Subject(s)
Decision Support Systems, Clinical/standards , Electronic Health Records/standards , Anthropology, Cultural , Computer Systems , Decision Support Systems, Clinical/organization & administration , Electronic Health Records/organization & administration , Humans , Interprofessional Relations , Interviews as Topic , Patient Safety , Qualitative Research , United States , User-Computer Interface , Workflow
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