Article

Governance for clinical decision support: case studies and recommended practices from leading institutions

Brigham and Women's Hospital, Boston, Massachusetts, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.93). 03/2011; 18(2):187-94. DOI: 10.1136/jamia.2009.002030
Source: PubMed

ABSTRACT Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study.
Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems.
Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys.
Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted.
Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support.

0 Followers
 · 
239 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Given the extensive data stored in healthcare data warehouses, data warehouse governance policies are needed to ensure data integrity and privacy. This review examines the current state of the data warehouse governance literature as it applies to healthcare data warehouses, identifies knowledge gaps, provides recommendations, and suggests approaches for further research. A comprehensive literature search using five data bases, journal article title-search, and citation searches was conducted between 1997 and 2012. Data warehouse governance documents from two healthcare systems in the USA were also reviewed. A modified version of nine components from the Data Governance Institute Framework for data warehouse governance guided the qualitative analysis. Fifteen articles were retrieved. Only three were related to healthcare settings, each of which addressed only one of the nine framework components. Of the remaining 12 articles, 10 addressed between one and seven framework components and the remainder addressed none. Each of the two data warehouse governance plans obtained from healthcare systems in the USA addressed a subset of the framework components, and between them they covered all nine. While published data warehouse governance policies are rare, the 15 articles and two healthcare organizational documents reviewed in this study may provide guidance to creating such policies. Additional research is needed in this area to ensure that data warehouse governance polices are feasible and effective. The gap between the development of data warehouses in healthcare settings and formal governance policies is substantial, as evidenced by the sparse literature in this domain.
    12/2013; 1(1). DOI:10.13063/2327-9214.1010
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose ‐ Brand equity of hospitals is built on patient care service quality. Through the testing of the hypotheses on the relationships between brand equity and its precursors, the purpose of this paper is to examine if clinical governance effectiveness is driven by corporate social responsibility (CSR), and if clinical governance effectiveness influences patient care service quality which in turn influences brand equity. Design/methodology/approach ‐ In total, 417 responses in completed form returned from self-administered structured questionnaires relayed to 835 clinical staff members underwent the structural equation modeling-based analysis. Findings ‐ CSR, as the data divulges, is a strong predictor of clinical governance effectiveness which yields high patient care quality and brand equity of the hospital. Originality/value ‐ The expedition to test research hypotheses constructed layer by layer of CSR-based model of hospital brand equity in which high levels of CSR among clinical members in the hospital activates clinical governance mechanism, without which, initiatives to improve patient care service quality may not be successfully implemented to augment brand equity of Vietnam-based hospitals.
    European Journal of Marketing 07/2014; 19(3). DOI:10.1108/CGIJ-02-2014-0007 · 0.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical decision support (CDS) systems link patient data with an electronic knowledge base in order to improve decision-making and computerised physician order entry (CPOE) is a requirement to set up electronic CDS. The medical informatics literature suggests categorising CDS tools into medication dosing support, order facilitators, point-of-care alerts and reminders, relevant information display, expert systems and workflow support. To date, CDS has particularly been recognised for improving processes. CDS successfully fostered prevention of deep-vein thrombosis, improved adherence to guidelines, increased the use of vaccinations, and decreased the rate of serious medication errors. However, CDS may introduce errors, and therefore the term "e-iatrogenesis" has been proposed to address unintended consequences. At least two studies reported severe treatment delays due to CPOE and CDS. In addition, the phenomenon of "alert fatigue" - arising from a high number of CDS alerts of low clinical significance - may facilitate overriding of potentially critical notifications. The implementation of CDS needs to be carefully planned, CDS interventions should be thoroughly examined in pilot wards only, and then stepwise introduced. A crucial feature of CPOE in combination with CDS is speed, since time consumption has been found to be a major factor determining failure. In the near future, the specificity of alerts will be improved, notifications will be prioritised and offer detailed advice, customisation of CDS will play an increasing role, and finally, CDS is heading for patient-centred decision support. The most important research question remains whether CDS is able to improve patient outcomes beyond processes.
    Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 12/2014; 144:w14073. DOI:10.4414/smw.2014.14073 · 1.88 Impact Factor

Full-text (2 Sources)

Download
98 Downloads
Available from
May 30, 2014