Duke University School of Nursing, Durham, North Carolina.
University of Utah College of Nursing, Salt Lake City, Utah.
J Am Med Inform Assoc. 2020 Apr 1;27(4):514-521. doi: 10.1093/jamia/ocz225.
The study sought to describe key features of clinical concepts and data required to implement clinical practice recommendations as clinical decision support (CDS) tools in electronic health record systems and to identify recommendation features that predict feasibility of implementation.
Using semistructured interviews, CDS implementers and clinician subject matter experts from 7 academic medical centers rated the feasibility of implementing 10 American College of Emergency Physicians Choosing Wisely Recommendations as electronic health record-embedded CDS and estimated the need for additional data collection. Ratings were combined with objective features of the guidelines to develop a predictive model for technical implementation feasibility.
A linear mixed model showed that the need for new data collection was predictive of lower implementation feasibility. The number of clinical concepts in each recommendation, need for historical data, and ambiguity of clinical concepts were not predictive of implementation feasibility.
The availability of data and need for additional data collection are essential to assess the feasibility of CDS implementation. Authors of practice recommendations and guidelines can enable organizations to more rapidly assess data availability and feasibility of implementation by including operational definitions for required data.
本研究旨在描述将临床实践建议实施为电子健康记录系统中的临床决策支持（CDS）工具所需的临床概念和数据的关键特征，并确定预测实施可行性的建议特征。
使用半结构化访谈，来自 7 家学术医疗中心的 CDS 实施者和临床主题专家对将 10 项美国急诊医师学会选择明智建议实施为电子健康记录嵌入式 CDS 的可行性进行了评估，并估计了额外数据收集的需求。这些评估与指南的客观特征相结合，为技术实施可行性开发了一个预测模型。
线性混合模型表明，新数据收集的需求预测了较低的实施可行性。每个建议中的临床概念数量、对历史数据的需求以及临床概念的模糊性都不能预测实施的可行性。
数据的可用性和额外数据收集的需求是评估 CDS 实施可行性的关键因素。实践建议和指南的作者可以通过为所需数据提供操作定义，使组织能够更快速地评估数据的可用性和实施的可行性。
