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CHQS Home » Projects » Health Information Technology » Clinical Decision Support in Community Hospitals: Barriers and Facilitators

Clinical Decision Support in Community Hospitals: Barriers and Facilitators

2009-2011

National Library of Medicine

Total award $400,000

PI: Dean Sittig

Project Description

Clinical decision support is key to computerized provider order entry success and safer, more efficient health care. Research at leading academic health centers indicates that when computerized provider order entry (CPOE) is coupled with clinical decision support (CDS), medical errors may decrease and costs drop. However, CPOE with CDS is not used in most community hospitals, which account for approximately 96% of all U.S. hospitals. This gap in CDS implementation between community and teaching hospitals portends serious consequences for health care quality, patient safety, and rising costs. This revised proposal outlines three aims, within a systems theory framework, to investigate CDS in community hospitals, and to collect and disseminate knowledge about what does and does not work. Research questions were:

  1. What are barriers to and facilitators for use of different types of CDS in community hospitals?
  2. What strategies have community hospitals used to lessen the barriers and strengthen the facilitators?

Progress and Outcomes

Grant funding ended 9/1/2011. See http://www.cdsconsortium.org

/accomplishments.asp

Relevant Publications

2013

  • Jones JB, Stewart WF, Darer JD, Sittig DF. Beyond the threshold: real-time use of evidence in practice. BMC Med Inform Decis Mak. 2013;13(1):47. Epub 2013 Apr 15.

2012

  • Wright A, Feblowitz JC, Pang JE, Carpenter JD, Krall MA, Middleton B, Sittig DF. Use of Order Sets in Inpatient Computerized Provider Order Entry Systems: A Comparative Analysis of Usage Patterns at Seven Sites. Int J Med Inform. 2012 Nov;81(11):733-45. Epub 2012 July 18.
  • Ash J, Sittig DF, Guappone KP, Dykstra R, Richardson J, Wright A, Carpenter J, McMullen C, Shapiro M, Bunce A, Middleton B. Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study. BMC Med Inform Decis Mak. 2012;12:6. Epub 2012 Feb 14.
  • Ash J, McCormack JL, Sittig DF, Wright A, McMullen C, Bates DW. Standard practices for computerized clinical decision support in community hospitals: a national survey. J Am Med Inform Assoc. 2012 Nov-Dec;19(6):980-7. Epub 2012 Jun 15.

2011

  • Sittig DF, Wright A, Meltzer S, Simonaitis L, Evans RS, Nichol WP, Ash JS, Middleton B. Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records. BMC Med Inform Decis Mak. 2011 Feb 17;11(1):13.
  • Wright A, Sittig DF, Ash JS, Bates DW, Feblowitz J, Fraser G, Maviglia SM, McMullen C, Nichol WP, Pang JE, Starmer J, Middleton B. Governance for clinical decision support: case studies and recommended practices from leading institutions. J Am Med Inform Assoc. 2011 Mar 1;18(2):187-94. Epub 2011 Jan 20.
  • Wright A, Sittig DF, Ash JS, Feblowitz J, Meltzer S, McMullen C, Guappone K, Carpenter J, Richardson J, Simonaitis L, Evans RS, Nichol WP, Middleton B. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems. J Am Med Inform Assoc. 2011 May 1;18(3):232-42. Epub 2011 Mar 17.
  • Ash JS, Sittig DF, Wright A, McMullen C, Shapiro M, Bunce A, Middleton B. Clinical decision support in small community practice settings: a case study. J Am Med Inform Assoc. 2011 Apr 19. [Epub ahead of print].

2010

  • Sittig DF, Wright A, Simonaitis L, Carpenter JD, Allen GO, Doebbeling BN, Sirajuddin AM, Ash JS, Middleton B. The state of the art in clinical knowledge management: An inventory of tools and techniques. Int J Med Inform. 2010 Jan; 79(1):44-57.
  • Sittig DF, Wright A, Tsurikova R, Ash JS, Middleton B. Recommendations for clinical guideline developers regarding clinical decision support-related standards. Proc Guidelines International Network 2010 appearing in Otolaryngol Head Neck Surg 2010;143(1S1):61-2.
  • Ash JS, Sittig DF, Dykstra R, Wright A, McMullen C, Richardson J, Middleton B. Identifying best practices for clinical decision support and knowledge management in the field. Stud Health Technol Inform. 2010;160(Pt 2):806-10.
  • McMullen CK, Ash JS, Sittig DF, Bunce A, Guappone K, Dykstra R, Carpenter J, Richardson J, Wright A. Rapid Assessment of Clinical Information Systems in the Healthcare Setting. An Efficient Method for Time-pressed Evaluation. Methods of Information in Medicine. 2010;50(2):1-9.

2009

  • Wright A, Sittig DF, Ash JS, Sharma S, Pang JE, Middleton B. Clinical Decision Support Capabilities of Commercially-available Clinical Information Systems. J Am Med Inform Assoc. 2009 Sept-Oct; 16(5): 637-44.

2008

  • Wright A, Bates DW, Middleton B, Hongsermeier T, Kashyap V, Thomas SM, Sittig DF. Creating and sharing clinical decision support content with Web 2.0: Issues and Examples. J Biomed Inform. 2009 Apr; 42(2): 334-46.

CDS Consortium Conference Papers

2011

  • Sittig DF, Wright A, Ash JS, Middleton B. A set of preliminary standards recommended for achieving a national repository of clinical decision support interventions. AMIA Annu Symp Proc. 2009 Nov 14;2009:614-8.
  • Ash J, Sittig D, McMullen C, McCormack J, Wright A, Bunce A, Wasserman J, Mohan V, Cohen D, Shapiro M, Middleton B. Studying the Vendor Perspective on Clinical Decision Support. AMIA Annu Symp Proc. 2011;2011:80-7. Epub 2011 Oct 22.

2010

  • Richardson J, Ash J, Sittig DF, Wright A, Dkystra R. Multiple Perspectives on the Meaning of Clinical Decision Support. AMIA Annu Symp Proc. 2010 Nov 13;2010:1427-31.
  • Wright A, Sittig DF, Carpenter J, Krall M, Pang J, Middleton B. Order Sets in Computerized Physician Order Entry Systems: an Analysis of Seven Sites. AMIA Annu Symp Proc. 2010 Nov 13;2010:892-6.

2009

  •  Sittig D, Wright A, Ash J, Middleton B. A Set of Preliminary Standards Recommended for Achieving a National Repository of Clinical Decision Support Interventions. Paper presented at: AMIA 2009 Annual Symposium; 2009 Nov 14-18; San Francisco, California.

CDS Consortium Conference Posters

2010

  • Meltzer S, Sittig DF, Wright A, Middleton B. Assessment of the Clinical Knowledge Management Capabilities of Nine Commercially-available Electronic Health Records. Poster session presented at: AMIA NOW!; 2010 May 25-27; Phoenix, Arizona.
  • Sittig DF, Wright A, Meltzer S, Middleton B. A Preliminary Assessment of the Clinical Knowledge Management Capabilities of Commercially-available Electronic Health Records. Poster session presented at: 13th International Congress on Medical Informatics; 2010 Sept 12-15; Cape Town, South Africa.

2009

  • Pang JE, Wright A, Sharma S, Sittig DF, Middleton B. Clinical Decision Support Capabilities of Commercial EHR Systems. Poster session presented at: 2009 AMIA Spring Congress; 2009 May 28-30; Orlando, Florida.
  • Pang JE, Wright A, Sharma S, Sittig DF, Middleton B. What are the Decision Support Capabilities of Commercial EHR Systems? Results of a Survey of Nine CCHIT-Certified Systems. Poster session presented at: Society of General Internal Medicine 32nd Annual Meeting; 2009 May 13-16; Miami Beach, Florida.

CDS Consortium Conference Panels

2009

  • Wright A, Sittig D, Tsurikova R, Middleton B. Knowledge Management for Clinical Decision Support. Panel session presented at: 2009 AMIA Spring Congress; 2009 May 28-30; Orlando, Florida.
  • Wright A, Bates DW, Middleton B, Nichol P, Sittig DF. Governance for Clinical Decision Support. Panel session presented at: AMIA 2009 Annual Symposium; 2009 Nov 14-18; San Francisco, California.

2008

  • Wright A, Bates DW, Middleton B, Thomas S, Sittig DF. Web 2.0 and Clinical Decision Support. Panel presented at: AMIA Annual Symposium; 2008 Nov 8-12; Washington, DC.

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