title: Clinical decision support in small community practice settings: a case study.
abstract: Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team of investigators identified barriers and facilitators to clinical decision support (CDS) implementation in a community setting, the Mid-Valley Independent Physicians Association in the Salem, Oregon area. The team used the Rapid Assessment Process, which included nine formal interviews with CDS stakeholders, and observation of 27 clinicians. The research team, which has studied 21 healthcare sites of various sizes over the past 12&emsp14;years, believes this site is an excellent example of an organization which is using a commercially available electronic-health-record system with CDS well. The eight-dimensional model proved useful as an organizing structure for the evaluation.
authors.affiliation: Oregon Health & Science University, Portland, Oregon, USA. ash@ohsu.edu
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.forename: Carmit
authors.initials: C
authors.lastname: McMullen
authors.forename: Michael
authors.initials: M
authors.lastname: Shapiro
authors.forename: Arwen
authors.initials: A
authors.lastname: Bunce
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D000555:Ambulatory Care Information Systems; D003153:Community Health Services / Q000458:organization & administration*; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D009922:Oregon; D019982:Organizational Case Studies; D009936:Organizational Innovation