A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success

J Am Med Inform Assoc. May-Jun 2014;21(3):464-72. doi: 10.1136/amiajnl-2013-001771. Epub 2013 Sep 2.


Objective: To describe the activities performed by people involved in clinical decision support (CDS) at leading sites.

Materials and methods: We conducted ethnographic observations at seven diverse sites with a history of excellence in CDS using the Rapid Assessment Process and analyzed the data using a series of card sorts, informed by Linstone's Multiple Perspectives Model.

Results: We identified 18 activities and grouped them into four areas. Area 1: Fostering relationships across the organization, with activities (a) training and support, (b) visibility/presence on the floor, (c) liaising between people, (d) administration and leadership, (e) project management, (f) cheerleading/buy-in/sponsorship, (g) preparing for CDS implementation. Area 2: Assembling the system with activities (a) providing technical support, (b) CDS content development, (c) purchasing products from vendors (d) knowledge management, (e) system integration. Area 3: Using CDS to achieve the organization's goals with activities (a) reporting, (b) requirements-gathering/specifications, (c) monitoring CDS, (d) linking CDS to goals, (e) managing data. Area 4: Participation in external policy and standards activities (this area consists of only a single activity). We also identified a set of recommendations associated with these 18 activities.

Discussion: All 18 activities we identified were performed at all sites, although the way they were organized into roles differed substantially. We consider these activities critical to the success of a CDS program.

Conclusions: A series of activities are performed by sites strong in CDS, and sites adopting CDS should ensure they incorporate these activities into their efforts.

Keywords: clinical decision support; governance; implementation; knowledge management; rapid assessment process.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Data Collection
  • Decision Making
  • Decision Support Systems, Clinical* / organization & administration
  • Electronic Health Records
  • Humans
  • Interviews as Topic
  • Knowledge Management
  • Personnel, Hospital*
  • Qualitative Research
  • Systems Integration
  • Workforce