Skip to main content

Best Practices for Implementation of Clinical Decision Support

  • Chapter
  • First Online:
Clinical Decision Support Systems

Part of the book series: Health Informatics ((HI))

Abstract

Implementation of clinical decision support (CDS) is the process by which knowledge about appropriate practice is integrated with systems that are designed to influence provider behavior. We describe a systematic and replicable approach to implementation of knowledge that proceeds from knowledge synthesis that defines ideal care through a knowledge formalization phase in which that knowledge is transformed so it can be processed by computers. Next the knowledge is fitted to local needs, capabilities, and constraints. Finally, new knowledge gained from the implementation completes a feedback loop to inform future decision support activities.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Berner ES. Clinical decision support systems: state of the art. Rockville, MD: Publication number 09-0069EF. Rockville: Agency for Healthcare Research and Quality; 2009.

    Google Scholar 

  2. Shiffman RN, Wright A. Evidence-based clinical decision support. Yearb Med Inform. 2013;8(1):20–7.

    Google Scholar 

  3. Institute of Medicine. Best care at lower cost: the path to continuously learning health care in America. Washington, DC: National Academies Press; 2013.

    Google Scholar 

  4. Institute of Medicine. Clinical practice guidelines we can trust. Washington, DC: National Academies Press; 2011.

    Google Scholar 

  5. Shiffman RN, Michel G, Rosenfeld RM, Davidson C. Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability. J Am Med Inform Assoc. 2012;19(1):94–101.

    Article  PubMed  Google Scholar 

  6. Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Intern Med. 2003;139:493–8.

    Article  PubMed  Google Scholar 

  7. Brouwers M, Kho M, Browman G, Burgers J, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J. 2010;182:E839–42.

    Article  Google Scholar 

  8. Shiffman RN, Dixon J, Brandt C, Essaihi A, Hsiao A, Michel G, et al. The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation. BMC Med Inform Decis Mak. 2005;5:23.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Patel VL, Allen VG, Arocha JF, Shortliffe EH. Representing clinical guidelines in GLIF: individual and collaborative expertise. J Am Med Inform Assoc. 1998;5:467–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ohno-Machado L, Gennari JH, Murphy SN, Jain NL, Tu SW, Oliver DE, et al. The guideline interchange format: a model for representing guidelines. J Am Med Inform Assoc. 1998;5:357–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. ASTM International. Standard specification for Guideline Elements Model version 3 (GEM III)-document model for clinical practice guidelines. Conshohocken, PA, 2012.

    Google Scholar 

  12. Guidelines Into Decision Support (GLIDES) (Connecticut). Available from: https://healthit.ahrq.gov/ahrq-funded-projects/guidelines-decision-support-glides. Accessed 9 Dec 2015.

  13. 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;16(5):637–44.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Horsky J, Schiff GD, Johnston D, Mercincavage L, Bell D, Middleton B. Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions. J Biomed Inform. 2012;45(6):1–10.

    Google Scholar 

  15. Shobha P, Edworthy J, Hellier E, Segar DL, Schedlbauer A, Avery A, et al. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems. J Am Med Inform Assoc. 2011;17:493–501.

    Google Scholar 

  16. Shiffman RN, Lomotan E, Michel G. Using action-types to design guideline implementation systems (Abstr). Presented at the 6th Conferencia Internacional da Guidelines International Network, Lisbon, 1 Novembro 2009. Abstract published in Acta Medica Portuguesa Volume 22:15; 2009.

    Google Scholar 

  17. Payne T, Hines L, Chan R, et al. Recommendations to improve the usability of drug-drug interaction clinical decision support alerts. J Am Med Inform Assoc. 2015;Epub ahead of print.

    Google Scholar 

  18. Bobb AM, Payne TH, Gross PA. Viewpoint: controversies surrounding use of order sets for clinical decision support in computerized provider order entry. J Am Med Inform Assoc. 2007;14:41–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tierney W, McDonald C, Martin D, Hui S, Rogers M. Computerized display of past test results. Ann Intern Med. 1987;107:569–74.

    Article  CAS  PubMed  Google Scholar 

  20. HL7 International. Context-aware knowledge retrieval application (Infobutton), Release 4. HL7 International; 2014.

    Google Scholar 

  21. James BC. Making it easy to do it right. N Engl J Med. 2001;345:991–3.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Richard N. Shiffman M.D., M.C.I.S. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Shiffman, R.N. (2016). Best Practices for Implementation of Clinical Decision Support. In: Berner, E. (eds) Clinical Decision Support Systems. Health Informatics. Springer, Cham. https://doi.org/10.1007/978-3-319-31913-1_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-31913-1_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31911-7

  • Online ISBN: 978-3-319-31913-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics