Oregon Health & Science University, Portland, Oregon, USA.
J Am Med Inform Assoc. 2012 Nov-Dec;19(6):980-7. doi: 10.1136/amiajnl-2011-000705. Epub 2012 Jun 15.
Computerized provider order entry (CPOE) with clinical decision support (CDS) can help hospitals improve care. Little is known about what CDS is presently in use and how it is managed, however, especially in community hospitals. This study sought to address this knowledge gap by identifying standard practices related to CDS in US community hospitals with mature CPOE systems.
Representatives of 34 community hospitals, each of which had over 5 years experience with CPOE, were interviewed to identify standard practices related to CDS. Data were analyzed with a mix of descriptive statistics and qualitative approaches to the identification of patterns, themes and trends.
This broad sample of community hospitals had robust levels of CDS despite their small size and the independent nature of many of their physician staff members. The hospitals uniformly used medication alerts and order sets, had sophisticated governance procedures for CDS, and employed staff to customize CDS.
The level of customization needed for most CDS before implementation was greater than expected. Customization requires skilled individuals who represent an emerging manpower need at this type of hospital.
These results bode well for robust diffusion of CDS to similar hospitals in the process of adopting CDS and suggest that national policies to promote CDS use may be successful.
计算机化医嘱录入（CPOE）与临床决策支持（CDS）可以帮助医院改善医疗服务。然而，目前对于社区医院中 CDS 的使用情况和管理方式，我们知之甚少。本研究旨在通过确定具有成熟 CPOE 系统的美国社区医院中与 CDS 相关的标准实践来填补这一知识空白。
对 34 家社区医院的代表进行了访谈，每家医院都有超过 5 年的 CPOE 经验，以确定与 CDS 相关的标准实践。采用描述性统计和定性方法分析数据，以识别模式、主题和趋势。
尽管这些社区医院规模较小，其医生员工也相对独立，但它们的 CDS 水平非常高。这些医院普遍使用药物警报和医嘱集，拥有复杂的 CDS 治理程序，并聘请员工来定制 CDS。
在实施之前，大多数 CDS 需要进行的定制程度超出了预期。定制需要代表该类型医院新兴人力需求的熟练人员。
这些结果预示着在采用 CDS 的过程中，类似的社区医院将能够成功推广 CDS，并表明促进 CDS 使用的国家政策可能会取得成功。
