Abstract
BackgroundComputerized clinical decision support (CDS) can help hospitals to improve healthcare. However, CDS can be problematic. The purpose of this study was to discover how the views of clinical stakeholders, CDS content vendors, and EHR vendors are alike or different with respect to challenges in the development, management, and use of CDS.MethodsWe conducted ethnographic fieldwork using a Rapid Assessment Process within ten clinical and five health information technology (HIT) vendor organizations. Using an inductive analytical approach, we generated themes from the clinical, content vendor, and electronic health record vendor perspectives and compared them.ResultsThe groups share views on the importance of appropriate manpower, careful knowledge management, CDS that fits user workflow, the need for communication among the groups, and for mutual strategizing about the future of CDS. However, views of usability, training, metrics, interoperability, product use, and legal issues differed. Recommendations for improvement include increased collaboration to address legal, manpower, and CDS sharing issues.ConclusionsThe three groups share thinking about many aspects of CDS, but views differ in a number of important respects as well. Until these three groups can reach a mutual understanding of the views of the other stakeholders, and work together, CDS will not reach its potential.
Highlights
Computerized clinical decision support (CDS) can help hospitals to improve healthcare
Using a constant comparative approach, we analyzed differences across the themes in the clinical, content vendor, and electronic health record (EHR) vendor groups to discover the perspective of each group related to each theme
Health information management (HIM) and administrative roles are those held by certified HIM professionals, quality improvement leadership, and administrators not at the vice presidential level
Summary
Computerized clinical decision support (CDS) can help hospitals to improve healthcare. The purpose of this study was to discover how the views of clinical stakeholders, CDS content vendors, and EHR vendors are alike or different with respect to challenges in the development, management, and use of CDS. Key stakeholder groups include healthcare providers and organizations, EHR system vendors, and commercial firms offering CDS content. Challenges beginning to explore CDS, we remained very open in our data gathering and analysis This meant that we conducted line-by-line coding of interview and fieldnote text documents and identified patterns and themes directly from the words of subjects. Each pair presented the final result of its coding to the multidisciplinary team of informatics, ethnographic, and clinical experts This coding process, as described in a prior paper [18] led to development of the patterns and themes described below. Using a constant comparative approach, we analyzed differences across the themes in the clinical, content vendor, and EHR vendor groups to discover the perspective of each group related to each theme
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