J Am Med Inform Assoc - Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems.

Tópicos

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Resumo

CKGROUND: Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems.OBJECTIVE: To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs.STUDY DESIGN AND METHODS: We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4).RESULTS: Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common.CONCLUSION: We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content.

Resumo Limpo

ckground clinic decis support cds valuabl tool improv healthcar qualiti lower cost howev comprehens taxonomi type cds limit research avail various cds tool across current electron health record ehr systemsobject develop valid taxonomi frontend cds tool assess support tool major commerci intern develop ehrsstudi design method use modifi delphi approach panel decis support expert develop taxonomi frontend cds tool base taxonomi survey cds tool sent purpos sampl commerci ehr vendor n lead healthcar institut intern develop stateoftheart ehr nresult respons receiv healthcar institut ehr vendor respons rate type cds tool identifi taxonomi found least one survey ehr system function present ehr medic dose support order facilit common avail class decis support expert system eg diagnost decis support ventil manag suggest least commonconclus develop valid comprehens taxonomi frontend cds tool subsequ survey commerci ehr vendor lead healthcar institut reveal small core set common cds tool identifi signific variabl remaind clinic decis support content

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