Evaluating Clinical Decision Support Rules as an Intervention in Clinician Workflows With Technology
Evaluating Clinical Decision Support Rules as an Intervention in Clinician Workflows With Technology
复制标题
DOI：
10.1097/ncn.0b013e3181f9dbb1
复制
发表时间：
2011-01-01
影响因子：
1.3
通讯作者：
Kramer, J. Michael
中科院分区：
文献类型：
--
作者：
Brokel, Jane M.;Schwichtenberg, Tamara J.;Kramer, J. Michael
在农村地区实施电子健康记录带来了城市医院所没有的新挑战。临床决策支持规则的准备、实施和维持需要对标准、内容设计、支持资源、专家知识等给予广泛关注。形成性评价被用来呈现临床决策支持规则实施的进展和演变，并在临床医生工作流程中用于电子健康记录。该农村医院能够使用其系统内五家城市医院的临床决策支持规则，以促进安全，防止错误，建立循证实践，并支持沟通。本文介绍了工具，以验证最初的54个临床决策支持规则在农村转诊医院和17个诊所使用。自2005年以来，研究医院增加了针对导管获得性尿路感染、深静脉血栓形成、心力衰竭等的特定系统临床决策支持规则。研究结果验证了临床决策支持规则在各研究中心的使用，以及使用现有指标衡量结果的能力。农村医院可以迅速克服障碍，准备和实施，以及持续使用临床决策支持规则与系统化的方法和支持结构。提出了一种用于将临床决策支持规则设计和验证到工作流过程中的模型。复制和重复使用临床决策支持规则模板以及遵循数据模型的数据规范，可以通过系统支持资源支持在随后的农村和关键接入医院中重新应用规则干预。
The implementation of electronic health records in rural settings generated new challenges beyond those seen in urban hospitals. The preparation, implementation, and sustaining of clinical decision support rules require extensive attention to standards, content design, support resources, expert knowledge, and more. A formative evaluation was used to present progress and evolution of clinical decision support rule implementation and use within clinician workflows for application in an electronic health record. The rural hospital was able to use clinical decision support rules from five urban hospitals within its system to promote safety, prevent errors, establish evidence-based practices, and support communication. This article describes tools to validate initial 54 clinical decision support rules used in a rural referral hospital and 17 used in clinics. Since 2005, the study hospital has added specific system clinical decision support rules for catheter-acquired urinary tract infection, deep venous thrombosis, heart failure, and more. The findings validate the use of clinical decision support rules across sites and ability to use existing indicators to measure outcomes. Rural hospitals can rapidly overcome the barriers to prepare and implement as well as sustain use of clinical decision support rules with a systemized approach and support structures. A model for design and validation of clinical decision support rules into workflow processes is presented. The replication and reuse of clinical decision support rule templates with data specifications that follow data models can support reapplication of the rule intervention in subsequent rural and critical access hospitals through system support resources.