Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, Rockville, MD, USA.
Int J Med Inform. 2012 Mar;81(3):157-65. doi: 10.1016/j.ijmedinf.2011.11.004. Epub 2011 Dec 26.
To investigate use of a new guideline-based, computerized clinical decision support (CCDS) system for asthma in a pediatric pulmonology clinic of a large academic medical center.
We conducted a qualitative evaluation including review of electronic data, direct observation, and interviews with all nine pediatric pulmonologists in the clinic. Outcome measures included patterns of computer use in relation to patient care, and themes surrounding the relationship between asthma care and computer use.
The pediatric pulmonologists entered enough data to trigger the decision support system in 397/445 (89.2%) of all asthma visits from January 2009 to May 2009. However, interviews and direct observations revealed use of the decision support system was limited to documentation activities after clinic sessions ended. Reasons for delayed use reflected barriers common to general medical care and barriers specific to subspecialty care. Subspecialist-specific barriers included the perceived high complexity of patients, the impact of subject matter expertise on the types of decision support needed, and unique workflow concerns such as the need to create letters to referring physicians.
Pediatric pulmonologists demonstrated low use of a computerized decision support system for asthma care because of a combination of general and subspecialist-specific factors. Subspecialist-specific factors should not be underestimated when designing guideline-based, computerized decision support systems for the subspecialty setting.
研究在大型学术医疗中心的儿科肺病诊所中使用基于新指南的计算机临床决策支持（CCDS）系统治疗哮喘的情况。
我们进行了定性评估，包括对电子数据的审查、直接观察以及对诊所的 9 位儿科肺病专家进行访谈。评估结果包括与患者护理相关的计算机使用模式，以及围绕哮喘护理与计算机使用之间关系的主题。
2009 年 1 月至 5 月期间，儿科肺病专家在所有哮喘就诊中输入了足够的数据，以触发决策支持系统对 445 次就诊中的 397 次（89.2%）进行干预。然而，访谈和直接观察显示，决策支持系统的使用仅限于诊室外结束后的文档记录活动。延迟使用的原因反映了一般医疗保健中常见的障碍和专科医疗保健中特有的障碍。专科特定的障碍包括患者的高复杂性、对决策支持类型的主题专业知识的影响，以及独特的工作流程问题，如需要向转诊医生写介绍信。
儿科肺病专家对基于计算机的哮喘护理决策支持系统的使用率较低，原因是综合了一般因素和专科特定因素。在为专科环境设计基于指南的计算机化决策支持系统时，不应低估专科特定因素。
