Brokel Jane M, Schwichtenberg Tamara J, Wakefield Douglas S, Ward Marcia M, Shaw Michael G, Kramer J Michael
University of Iowa, Iowa City, IA 52242, USA.
Comput Inform Nurs. 2011 Jan-Feb;29(1):36-42. doi: 10.1097/NCN.0b013e3181f9dbb1.
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.
在农村地区实施电子健康记录带来了一些城市医院未曾出现过的新挑战。临床决策支持规则的准备、实施和持续应用需要对标准、内容设计、支持资源、专业知识等给予广泛关注。采用了一项形成性评估来展示临床决策支持规则在临床医生工作流程中的实施进展和演变情况，以便应用于电子健康记录。这家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、预防差错、建立循证实践并支持沟通。本文介绍了用于验证一家农村转诊医院使用的最初54条临床决策支持规则以及诊所使用的17条规则的工具。自2005年以来，研究医院针对导管相关尿路感染、深静脉血栓形成、心力衰竭等情况增加了特定的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不同地点的使用情况以及利用现有指标衡量结果的能力。农村医院可以通过系统化方法和支持结构迅速克服准备、实施以及持续使用临床决策支持规则的障碍。本文还介绍了将临床决策支持规则设计并验证到工作流程中的模型。具有遵循数据模型的数据规范的临床决策支持规则模板的复制和重用，可以通过系统支持资源，在后续的农村医院和临界接入医院中支持规则干预的重新应用。
