Department of Public Health, Weill Cornell Medical College, New York City, New York 10065, USA.
J Am Med Inform Assoc. 2011 Dec;18 Suppl 1(Suppl 1):i28-35. doi: 10.1136/amiajnl-2011-000119. Epub 2011 Sep 2.
To conduct a grounded needs assessment to elicit community-based physicians' current views on clinical decision support (CDS) and its desired capabilities that may assist future CDS design and development for community-based practices.
To gain insight into community-based physicians' goals, environments, tasks, and desired support tools, we used a human-computer interaction model that was based in grounded theory. We conducted 30 recorded interviews with, and 25 observations of, primary care providers within 15 urban and rural community-based clinics across Oregon. Participants were members of three healthcare organizations with different commercial electronic health record systems. We used a grounded theory approach to analyze data and develop a user-centered definition of CDS and themes related to desired CDS functionalities.
Physicians viewed CDS as a set of software tools that provide alerts, prompts, and reference tools, but not tools to support patient management, clinical operations, or workflow, which they would like. They want CDS to enhance physician-patient relationships, redirect work among staff, and provide time-saving tools. Participants were generally dissatisfied with current CDS capabilities and overall electronic health record usability.
Physicians identified different aspects of decision-making in need of support: clinical decision-making such as medication administration and treatment, and cognitive decision-making that enhances relationships and interactions with patients and staff.
Physicians expressed a need for decision support that extended beyond their own current definitions. To meet this requirement, decision support tools must integrate functions that align time and resources in ways that assist providers in a broad range of decisions.
进行扎根需求评估，以了解社区医生对临床决策支持（CDS）的当前看法及其期望的功能，这可能有助于未来社区实践的 CDS 设计和开发。
为了深入了解社区医生的目标、环境、任务和所需的支持工具，我们使用了基于扎根理论的人机交互模型。我们对俄勒冈州 15 家城市和农村社区诊所的 30 名初级保健提供者进行了记录访谈，并进行了 25 次观察。参与者来自三个具有不同商业电子健康记录系统的医疗保健组织。我们使用扎根理论方法分析数据，并开发了一个以用户为中心的 CDS 定义以及与期望 CDS 功能相关的主题。
医生将 CDS 视为一组软件工具，提供警报、提示和参考工具，但不是支持患者管理、临床操作或工作流程的工具，这是他们所希望的。他们希望 CDS 能够增强医患关系，重新分配员工的工作，并提供节省时间的工具。参与者普遍对当前 CDS 功能和整体电子健康记录的可用性不满意。
医生确定了需要支持的决策的不同方面：临床决策，如药物管理和治疗，以及认知决策，增强了与患者和员工的关系和互动。
医生表示需要超越自身当前定义的决策支持。为了满足这一需求，决策支持工具必须集成功能，以帮助提供者在广泛的决策中协调时间和资源。
