title: Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records.
abstract: BACKGROUND
  We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria.
  
  
  METHODS
  We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content.
  
  
  RESULTS
  All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified.
  
  
  CONCLUSIONS
  If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.
authors.affiliation: UTHealth-Memorial Hermann Center for Healthcare Quality & Safety, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA. dean.f.sittig@uth.tmc.edu
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.forename: Seth
authors.initials: S
authors.lastname: Meltzer
authors.forename: Linas
authors.initials: L
authors.lastname: Simonaitis
authors.forename: R Scott
authors.initials: RS
authors.lastname: Evans
authors.forename: W Paul
authors.initials: WP
authors.lastname: Nichol
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D003625:Data Collection; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D058436:Knowledge Management; D010045:Outpatients