Int J Med Inform - Evaluating the use of a computerized clinical decision support system for asthma by pediatric pulmonologists.

Tópicos

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Resumo

RPOSE: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

Resumo Limpo

rpose investig use new guidelinebas computer clinic decis support ccds system asthma pediatr pulmonolog clinic larg academ medic centermethod conduct qualit evalu includ review electron data direct observ interview nine pediatr pulmonologist clinic outcom measur includ pattern comput use relat patient care theme surround relationship asthma care comput useresult pediatr pulmonologist enter enough data trigger decis support system asthma visit januari may howev interview direct observ reveal use decis support system limit document activ clinic session end reason delay use reflect barrier common general medic care barrier specif subspecialti care subspecialistspecif barrier includ perceiv high complex patient impact subject matter expertis type decis support need uniqu workflow concern need creat letter refer physiciansconclus pediatr pulmonologist demonstr low use computer decis support system asthma care combin general subspecialistspecif factor subspecialistspecif factor underestim design guidelinebas computer decis support system subspecialti set

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