Health Services Research & Development

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2006 HSR&D National Meeting Abstract


2008 — Clinical Decision Support Systems: The Iterative Process of Design

Author List:
Browning MM (Edward Hines Jr VA Hospital)
Hynes DM (Edward Hines Jr VA Hospital)
Goldstein MK (VA Palo Alto Health Care System)
Daniels D (Palo Alto Health Care System)
Cohen AN (VA Greater Los Angeles Healthcare System)
Young AS (VA Greater Los Angeles Healthcare System)
Doebbeling BN (Richard L Roudebush VA Medical Center)

Objectives:
Health care in the VA and across the United States is increasingly focused on managing chronic disease, and medical organizations are focused on implementing evidence-based guidelines developed for providing optimal care. Clinical decision support systems (CDSSs) available to providers at the point of service are potentially ideal for guideline implementation. However, research suggests that designing CDSSs that are actually used and that actually succeed in facilitating adoption of guidelines is an organizational challenge. To help VA researchers interested in developing CDSSs, this workshop will present accounts from four VA HSR&D and QUERI-funded projects describing experiences in the iterative process of designing effective CDSSs.

Methods:
The workshop panel will address development issues, from operationalizing guidelines to obtaining local and national VA technical support to evaluation strategies. (1) A CDSS for the treatment of hypertension (Assessment and Treatment of Healthcare: Evidence-Based Automation Decision Support System Hypertension or ATHENA DSS Hypertension) has been developed and tested in three VA medical centers. Dr. Goldstein will discuss the “sociotechnical” approach adopted in its development, where explicit attention was paid to organizational context. (2) Another VA project is currently adapting ATHENA DSS for use of opioid therapy in the management of chronic pain. Dr. Daniels will describe modifying this existing CDSS for implementing a pain management guideline. (3) A tool known as Medical Informatics Network Tool or MINT to support collaborative care for veterans with schizophrenia has been tested in two VA medical centers. Dr. Cohen will report on the development of this tool. (4) Creating HealtheVet Informatics Applications for Collaborative Care (CHIACC) has recently established an expert consensus from VA and non-VA stakeholders for the required structure and content of an informatics module for chronic illness collaborative care. Dr. Young will discuss the development of this module, including requirements for decision support. Finally, Dr. Doebbeling will provide an overview of lessons learned in the VA experience of designing CDSSs.

Results:
For VA researchers working on guideline implementation, this workshop will provide an opportunity to learn about developing effective clinical decision support systems for promoting the adoption of clinical practice guidelines.

Implications:
Acquaintance with the concept of CDSS helpful.

Impacts: