Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
J Am Med Inform Assoc. 2019 Dec 1;26(12):1515-1524. doi: 10.1093/jamia/ocz124.
We developed and piloted a process for sharing guideline-based clinical decision support (CDS) across institutions, using health screening of newly arrived refugees as a case example.
We developed CDS to support care of newly arrived refugees through a systematic process including a needs assessment, a 2-phase cognitive task analysis, structured preimplementation testing, local implementation, and staged dissemination. We sought consensus from prospective users on CDS scope, applicable content, basic supported workflows, and final structure. We documented processes and developed sharable artifacts from each phase of development. We publically shared CDS artifacts through online dissemination platforms. We collected feedback and implementation data from implementation sites.
Responses from 19 organizations demonstrated a need for improved CDS for newly arrived refugee patients. A guided multicenter workflow analysis identified 2 main workflows used by organizations that would need to be supported by shared CDS. We developed CDS through an iterative design process, which was successfully disseminated to other sites using online dissemination repositories. Implementation sites had a small-to-modest analyst time commitment but reported a good match between CDS and workflow.
Sharing of CDS requires overcoming technical and workflow barriers. We used a guided multicenter workflow analysis and online dissemination repositories to create flexible CDS that has been adapted at 3 sites. Organizations looking to develop sharable CDS should consider evaluating the workflows of multiple institutions and collecting feedback on scope, design, and content in order to make a more generalizable product.
我们开发并试行一种在机构间共享基于指南的临床决策支持（CDS）的流程，以新到难民健康筛查为例。
我们通过一个系统的流程来开发 CDS，以支持新到难民的护理，该流程包括需求评估、两阶段认知任务分析、结构化预实施测试、本地实施和分阶段传播。我们寻求潜在用户对 CDS 范围、适用内容、基本支持工作流程和最终结构的共识。我们记录了每个开发阶段的流程和可共享的制品。我们通过在线传播平台公开分享 CDS 制品。我们从实施点收集反馈和实施数据。
来自 19 个组织的回应表明，新到难民患者需要改进 CDS。一项引导式多中心工作流程分析确定了组织需要支持的 2 种主要工作流程。我们通过迭代设计过程开发了 CDS，成功地通过在线传播库传播到其他站点。实施点的分析师投入时间较小，但报告称 CDS 与工作流程匹配良好。
共享 CDS 需要克服技术和工作流程障碍。我们使用引导式多中心工作流程分析和在线传播库来创建灵活的 CDS，该 CDS已在 3 个站点进行了调整。希望开发可共享 CDS 的组织应考虑评估多个机构的工作流程，并收集有关范围、设计和内容的反馈，以便制作更具通用性的产品。
