title: Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study.
abstract: BACKGROUND
  The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S.
  
  
  METHODS
  Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices.
  
  
  RESULTS
  The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction.
  
  
  CONCLUSIONS
  These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.
authors.affiliation: Oregon Health & Science University, Portland, OR, 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: Kenneth P
authors.initials: KP
authors.lastname: Guappone
authors.forename: Richard H
authors.initials: RH
authors.lastname: Dykstra
authors.forename: Joshua
authors.initials: J
authors.lastname: Richardson
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.forename: James
authors.initials: J
authors.lastname: Carpenter
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: D020000:Decision Support Systems, Clinical / Q000458:organization & administration / Q000592:standards; D004059:Diffusion of Innovation; D005260:Female; D006287:Health Planning Guidelines; D006764:Hospitals, Community; D006801:Humans; D007318:Inservice Training; D007324:Institutional Management Teams; D007400:Interprofessional Relations; D058436:Knowledge Management; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D017064:Process Assessment, Health Care; D036301:Qualitative Research; D012108:Research Personnel; D012944:Social Support; D013597:Systems Analysis; D014481:United States