Developing and implementing clinical decision support for use in a computerized prescriber-order-entry system

Abstract

Through an interdisciplinary collaboration, an academic health care system planned, designed, and implemented institution-specific, CPOE-integrated CDS to improve clinical efficiency and facilitate the compliance with regulatory policies and guidelines.

Improving Provider Adoption With Adaptive Clinical Decision Support Surveillance: An Observational Study (Preprint)

“…We have demonstrated that postimplementation tracking and iterative changes to a deployed CDS can result in a 4.5-fold increase in adoption rate. Similar mechanisms have been implemented to track effectiveness of CDS; Zimmerman et al devised monthly reports on alert occurrence and override rates organized into a dashboard view [39]. Using post-implementation tracking methods such as this allows for development of novel metrics for predicting inappropriate alerts and responses.…”

Cost and turn-around time display decreases inpatient ordering of reference laboratory tests: a time series

“…Adoption of these systems may offer many institutional benefits including reduced test turn-around time (TAT), improved test usage, and better adherence to practice guidelines 14–19. Specifically, these systems may alert physicians to test-specific inappropriate ordering, provide alternative tests to consider, list cost information, and suggest order sets for bundled ordering 15 20. Use of CPOE alert systems have been shown to improve ordering of certain tests including cardiac markers in certain appropriate situations,21 as well as to improve compliance with the American Heart Association guidelines for cardiac monitoring 22.…”

National standards for computerized prescriber order entry and clinical decision support: The case of drug interactions

“…During CPOE implementation, decisions need to be made about the numerous configuration options that affect the manner in which clinicians work, how the system functions, and, potentially, the clinical outcome of patient experiences. 9,14 While the optimal configuration of CPOE is unclear, the failure to consider sitespecific characteristics and workflow when configuring a CPOE system is a potential cause of unintended consequences. 13,15,16 Evidence-based standardization could dramatically reduce the financial and human resources needed for implementation of these systems, especially if vendor CPOE systems are preconfigured accordingly.…”

“…These methods are discussed in greater detail elsewhere. 14,22 Standards and certifications. Complicating the matter of configuring optimal CDS alerting methods are CPOE and CDS standard-setting initiatives by government and private organizations.…”