Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study

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