According to survey results of 34 community hospitals, each with more than five years of experience with computerized physician order entry (CPOE), the national policies to promote clinical decision support (CDS) use may be successful.
Published June 15 in the Journal of the Medical Informatics Association , Joan S. Ash, PhD, MBA, of the Oregon Health & Science University in Portland, and colleagues sought to address the lack of knowledge about CDS use and management, especially in community hospitals, by identifying standard practices related to CDS in U.S. community hospitals with mature CPOE systems.
Representatives from the 34 hospitals were interviewed and data were analyzed with a mix of descriptive statistics and qualitative approaches to the identification of patterns, themes and trends. The sample had robust levels of CDS despite their small size and the independent nature of many of their physician staff members, according to the researchers. “The hospitals uniformly used medication alerts and order sets, had sophisticated governance procedures for CDS and employed staff to customize CDS.”
The average percentage of orders entered using CPOE ranged from 72 to 83 percent, the authors found. All hospitals reported that they had order sets and medication alerts, according to the results. “Seven respondents replied that medication alerts are provided by vendors, eight said they self-develop them and others did not respond to the question,” the authors wrote. “Also, 88 percent reported having other alerts or reminders in addition to medication alerts. Eleven noted that these additional alerts or reminders are self-developed, with only two reporting that vendors supply them and others not responding to the question. Overall, 68 percent reported having documentation templates.”
Assessing how CDS is performing, 11 out of 23 respondents noted their hospitals tracked alert override rates to ensure the physicians were not overburdened with alerts. Fifteen of 18 responding hospitals tracked which physicians were using CPOE so they could encourage greater use.
When asked if respondents trusted the data attributed to CPOE, 10 out of 17 responding answered ‘yes’, but four were unsure about the quality of data entered by busy clinicians, the researchers stated.
Of the 34 interviewees, 32 replied to the question about facilitators. “The most frequently mentioned facilitator was user involvement and the importance of training users (19/32),” the authors wrote. “Many (11/32) noted the value of top-level support and leadership. Respondents said you should try to save clinicians' time (7/32), target the right CDS to the most appropriate clinician (7/32) or link CDS to quality initiatives (6/32) or evidence-based medicine (4/32).”
The level of customization needed for most CDS before implementation was greater than expected, noted the authors. “Customization requires skilled individuals who represent an emerging manpower need at this type of hospital.”
The authors asserted that their results suggest within their sample nearly all hospitals had developed a sophisticated CPOE system. “These results bode well for robust diffusion of CDS to similar hospitals in the process of adopting CDS and suggest that national policies to promote CDS use may be successful,” the authors concluded. “Nonetheless, there is a manpower shortage of people with the key skills, and the needs of community hospitals for skilled staff members who can customize and manage CDS needs to be addressed on a continuing basis by the workforce development initiatives of the Office of the National Coordinator for Health IT.”