title: Expert clinical rules automate steps in delivering evidence-based care in the electronic health record.
abstract: A working framework is presented for interdisciplinary professionals for designing, building, and evaluating clinical decision support rules (expert rules) within the electronic health record. The working framework outlines the key workflow processes for eight health system organizations for selecting, designing, building, activating, and evaluating rules. In preparation, an interdisciplinary team selected expert rules for their organizations. A physician, a nurse, and/or pharmacy informatics specialists led the team for each organization. The team chose from a catalog of expert rules that were supported by regulatory or clinical evidence. The design process ensured that each expert rule followed evidence-based guidelines and was programmed to automate steps in planning and delivering patient care. Expert rules were prioritized when improving the safety and quality of care. Finally, clinical decision support rules were evaluated for abilities to improve the consistency and currency of assessments and follow-through on patient findings from these assessments. The informatics specialists from each of the health system organizations also participated in a health system oversight group to construct the key processes for this beginning framework. The group refined the processes for the selection, design, construction, activation, and evaluation of expert rules over the past 3 years. These steps offered direction to subsequent clinic and hospital organizations in a similar situation. This case study identified four key considerations when implementing and evaluating the clinical decision support expert rules within care delivery. In summary, the processes for decision support expert rules required rigorous development and change control processes to support operation.
authors.affiliation: College of Nursing, University of Iowa, Iowa City, 52242-1121, USA. jane-brokel@uiowa.edu
authors.forename: Jane M
authors.initials: JM
authors.lastname: Brokel
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shaw
authors.forename: Cindy
authors.initials: C
authors.lastname: Nicholson
mesh_terms: D003659:Decision Making, Organizational; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005103:Expert Systems; D006751:Hospital Information Systems / Q000458:organization & administration*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D017146:Models, Organizational; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011682:Purchasing, Hospital / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration