Ken Guappone

Publications of Ken Guappone

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

  Authors: Adam Wright, Dean F Sittig, Joan S Ash, Joshua Feblowitz, Seth Meltzer, Carmit McMullen, Ken Guappone, Jim Carpenter, Joshua Richardson, Linas Simonaitis, R Scott Evans, W Paul Nichol, Blackford Middleton

  Journal of the American Medical Informatics Association : JAMIA. 03/2011; 18(3):232-42.

  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 researchClinical 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. 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. 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). 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. 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.

• Multiple perspectives on the meaning of clinical decision support.

  Authors: Joshua E Richardson, Joan S Ash, Dean F Sittig, Arwen Bunce, James Carpenter, Richard H Dykstra, Ken Guappone, Carmit K McMullen, Michael Shapiro, Adam Wright

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:672-6.

  Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of a consensus around what is meant by CDS represents a barrier to effective design,Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of a consensus around what is meant by CDS represents a barrier to effective design, use, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how different people define and describe CDS. Using subjects' multiple perspectives we were able to gain new insights as to what stakeholders want CDS to achieve and how to achieve it; even at times when those perspectives are competing and conflicting.

• Multiple perspectives on the meaning of clinical decision support.

  Authors: Joshua E Richardson, Joan S Ash, Dean F Sittig, Arwen Bunce, James Carpenter, Richard H Dykstra, Ken Guappone, James McCormack, Carmit K McMullen, Michael Shapiro, Adam Wright, Blackford Middleton

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:1427-31.

  Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of consensus about what is meant by CDS represents a barrier to effective design,Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how different people define and describe CDS. Using subjects' multiple perspectives we were able to gain new insights as to what stakeholders want CDS to achieve and how to achieve it even when those perspectives are competing and conflicting.

• Persistent paper: the myth of "going paperless".

  Authors: Richard H Dykstra, Joan S Ash, Emily Campbell, Dean F Sittig, Ken Guappone, James Carpenter, Joshua Richardson, Adam Wright, Carmit McMullen

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2009; 2009:158-62.

  How does paper usage change following the introduction of Computerized Physician Order Entry and the Electronic Medical Record (EMR/CPOE)? To answer that question we analyzed data collected fromHow does paper usage change following the introduction of Computerized Physician Order Entry and the Electronic Medical Record (EMR/CPOE)? To answer that question we analyzed data collected from fourteen sites across the U.S. We found paper in widespread use in all institutions we studied. Analysis revealed psychological, ergonomic, technological, and regulatory reasons for the persistence of paper in an electronic environment. Paper has unique attributes allowing it to fill gaps in information timeliness, availability, and reliability in pursuit of improved patient care. Creative uses have led to "better paper."

• Field evaluation of commercial computerized provider order entry systems in community hospitals.

  Authors: Ken Guappone, Joan Ash, Dean Forrest Sittig

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 02/2008;

  Computerized Provider Order Entry (CPOE) is an important component of the electronic health record, but there has been some difficulty with user acceptance, and this is often due to poor computerComputerized Provider Order Entry (CPOE) is an important component of the electronic health record, but there has been some difficulty with user acceptance, and this is often due to poor computer interface usability which disrupts clinician workflow. This qualitative research employed usability engineering methods to study community hospital physicians using commercial CPOE systems while in a naturalistic context. Numerous usability problems were uncovered with this effective technique. Field usability testing should be considered in all institutions implementing CPOE or other clinical computer applications as a means of improving the usability and acceptance of those systems.

• A rapid assessment process for clinical informatics interventions.

  Authors: Joan Ash, Dean Forrest Sittig, Carmit K McMullen, Ken Guappone, Richard Dykstra, James Carpenter

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 02/2008;

  Informatics interventions generally take place in rapidly changing settings where many variables are outside the control of the evaluator. Assessment must be timely so that feedback can instigateInformatics interventions generally take place in rapidly changing settings where many variables are outside the control of the evaluator. Assessment must be timely so that feedback can instigate modification of the intervention. Adapting a methodology from international health and epidemiology, we have developed and refined a Rapid Assessment Process (RAP) for informatics while conducting a study of clinical decision support (CDS) in community hospitals. Using RAP, we have not only been able to provide implementers with actionable feedback, but we have also discovered that users and informaticians conceptualize CDS in vastly different ways. Further understanding of this difference will be needed if we are to improve CDS acceptance by users.

• A survey of U.S.A. acute care hospitals' computer-based provider order entry system infusion levels.

  Authors: Dean F Sittig, Ken Guappone, Emily M Campbell, Richard H Dykstra, Joan S Ash

  Studies in health technology and informatics. 02/2007; 129(Pt 1):252-6.

  We developed and fielded a survey to help clinical information system designers, developers, and implementers better understand the infusion level, or the extent and sophistication of CPOE featureWe developed and fielded a survey to help clinical information system designers, developers, and implementers better understand the infusion level, or the extent and sophistication of CPOE feature availability and use by clinicians within acute care hospitals across the United States of America. In the 176 responding hospitals, we found that CPOE had been in place a median of 5 years and that the median percentage of orders entered electronically was 90.5%. Greater than 96% of the sites used CPOE to enter pharmacy, laboratory and imaging orders; 82% were able to access all aspects of the clinical information system with a single sign-on; 86% of the respondents had order sets, drug-drug interaction warnings, and pop-up alerts even though nearly all hospitals were community hospitals with commercial systems; and 90% had a CPOE committee with a clinician representative in place. While CPOE has not been widely adopted after over 30 years of experimentation, there is still much that can be learned from this relatively small number of highly infused (with CPOE and clinical decision support) organizations.

• Recommendations for monitoring and evaluation of in-patient Computer-based Provider Order Entry systems: results of a Delphi survey.

  Authors: Dean F Sittig, Emily Campbell, Ken Guappone, Richard Dykstra, Joan S Ash

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 02/2007;

  A survey of 20 clinical informaticists with experience in implementing Computer-based Provider Order Entry (CPOE) systems revealed the lack of easily accessible measurements of success. Using aA survey of 20 clinical informaticists with experience in implementing Computer-based Provider Order Entry (CPOE) systems revealed the lack of easily accessible measurements of success. Using a Delphi approach, the authors, together with a group of CPOE experts, selected eight key CPOE-related measures to assess system availability, use, benefits, and e-Iatrogenesis. We suggest collecting these measures on a widespread/national basis would be wise stewardship and result in tighter feedback about both clinician workflow and patient safety. Establishing reliable benchmarks against which new implementations and existing systems can be compared will enhance organizations' ability to effectively manage and hence to realize the full benefits of their CPOE implementations.