Governance for clinical decision support: case studies and recommended practices from leading institutions.
OBJECTIVE
Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study.


METHODS
Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems.


METHODS
Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys.


RESULTS
Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted.


CONCLUSIONS
Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support.
Brigham and Women's Hospital, Boston, Massachusetts, USA. awright5@partners.org
Adam
A
Wright
Dean F
DF
Sittig
Joan S
JS
Ash
David W
DW
Bates
Joshua
J
Feblowitz
Greg
G
Fraser
Saverio M
SM
Maviglia
Carmit
C
McMullen
W Paul
WP
Nichol
Justine E
JE
Pang
Jack
J
Starmer
Blackford
B
Middleton
D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D006284:Health Plan Implementation; D006801:Humans; D019982:Organizational Case Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D014481:United States
Ann Intern Med. 2004 Dec 21;141(12):938-45
15611491
Endocr Pract. 2009 May-Jun;15(4):370-6
19454383
Proc AMIA Symp. 1999;:770-4
10566464
AMIA Annu Symp Proc. 2003;:376-80
14728198
Int J Med Inform. 2010 Jan;79(1):44-57
19828364
J Am Med Inform Assoc. 2005 Jul-Aug;12(4):365-76
15802474
AMIA Annu Symp Proc. 2008 Nov 06;:953
18999094
J Am Med Inform Assoc. 2009 Jan-Feb;16(1):40-6
18952941
J Biomed Inform. 2005 Dec;38(6):469-85
16290243
J Am Med Inform Assoc. 2003 Nov-Dec;10(6):523-30
12925543
AMIA Annu Symp Proc. 2005;:1071
16779358
AMIA Annu Symp Proc. 2007 Oct 11;:910
18694010
Proc AMIA Symp. 2000;:2-6
11080034
Stud Health Technol Inform. 2009;150:26-30
19745260
J Gen Intern Med. 2008 Apr;23(4):392-8
18373135
J Biomed Inform. 2009 Apr;42(2):334-46
18935982
JAMA. 2005 Mar 9;293(10):1223-38
15755945
J Am Med Inform Assoc. 2006 Jan-Feb;13(1):5-11
16221941
Stud Health Technol Inform. 2010;160(Pt 2):806-10
20841797
AMIA Annu Symp Proc. 2007 Oct 11;:94-8
18693805
AMIA Annu Symp Proc. 2007 Oct 11;:671-5
18693921
Mod Healthc. 2004 Feb 23;34(8):16
15015393
Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:89-106
19672686
BMJ. 2005 Apr 2;330(7494):765
15767266
Ann Intern Med. 2006 May 16;144(10):742-52
16702590
Methods Inf Med. 2011;50(4):299-307
21170469
J Biomed Inform. 2008 Apr;41(2):387-92
18029232