Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients.

BACKGROUND: Clinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T). METHODS: A questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed. RESULTS: The response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01). CONCLUSIONS: Both cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.

From data to knowledge: a method for modeling hospital logistic processes.

When modeling or redesigning a process, the knowledge-management perspective is seldomly used. Using the knowledge categorization developed by van Heusden and Jorna, we propose a knowledge-management perspective to provide a strategy for modeling and redesigning a business process. As an illustration of our approach, we use hospital data of multidisciplinary patients. This specific group of patients requires the involvement of different specialisms for their medical treatment that leads to more efforts regarding the coordination of care for these patients. In order to increase the care efficiency, knowledge that supports the reorganization of care for multidisciplinary patients should be provided. We use the above-mentioned knowledge-management perspective for creating new multidisciplinary units, in which different specialisms coordinate the treatment of specific groups of patients.

Planners and their cognitive maps: an analysis of domain representations using multi dimensional scaling.

We expected planners working on the planning problems at a particular department for many years to have similar ideas about their work domain. However, we found the opposite when we analyzed the results of an extensive knowledge elicitation study we performed on 25 planners working in the rolling stock and rolling staff planning department of the Netherlands Railways (in Dutch: NS). The planners were asked to model their domain by means of card sorting and graph-positioning methods using domain-related objects and relations. When we applied multi dimensional scaling to the outcome of this study, we found large differences in the individual cognitive maps thus created. In this article, we describe the analyses and discuss our findings about planners' cognitive maps. These maps may have implications for the organization of planning in general, for training of planners, and for software design.