Michael Shapiro

Publications of Michael Shapiro

• Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study.

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

  BMC medical informatics and decision making. 02/2012; 12(1):6.

  ABSTRACT: BACKGROUND: The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM)ABSTRACT: BACKGROUND: The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. METHODS: Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. RESULTS: The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. CONCLUSIONS: These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.

• Clinical decision support in small community practice settings: a case study.

  Authors: Joan S Ash, Dean F Sittig, Adam Wright, Carmit McMullen, Michael Shapiro, Arwen Bunce, Blackford Middleton

  Journal of the American Medical Informatics Association : JAMIA. 04/2011; 18(6):879-82.

  Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team of investigators identified barriers and facilitators to clinical decision support (CDS) implementationUsing an eight-dimensional model for studying socio-technical systems, a multidisciplinary team of investigators identified barriers and facilitators to clinical decision support (CDS) implementation in a community setting, the Mid-Valley Independent Physicians Association in the Salem, Oregon area. The team used the Rapid Assessment Process, which included nine formal interviews with CDS stakeholders, and observation of 27 clinicians. The research team, which has studied 21 healthcare sites of various sizes over the past 12 years, believes this site is an excellent example of an organization which is using a commercially available electronic-health-record system with CDS well. The eight-dimensional model proved useful as an organizing structure for the evaluation.

• Studying the vendor perspective on clinical decision support.

  Authors: Joan S Ash, Dean F Sittig, Carmit K McMullen, James L McCormack, Adam Wright, Arwen Bunce, Joseph Wasserman, Vishnu Mohan, Deborah J Cohen, Michael Shapiro, Blackford Middleton

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2011; 2011:80-7.

  In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provideIn prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provide only one perspective related to the CDS landscape, which also includes content vendors and electronic health record (EHR) vendors. To discover content vendors' perspectives and their perceived challenges, we modified RAP for industrial settings. We describe how we employed RAP, and show its utility by describing two illustrative themes. We found that while the content vendors believe they provide unique much-needed services, the amount of labor involved in content development is underestimated by others. We also found that the content vendors believe their products are resources to be used by practitioners, so they are somewhat protected from liability issues. To promote adequate understanding about these issues, we recommend a "three way conversation" among content vendors, EHR vendors, and user organizations.

• 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.