title: A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success.
abstract: OBJECTIVE
  To describe the activities performed by people involved in clinical decision support (CDS) at leading sites.
  
  
  METHODS
  We conducted ethnographic observations at seven diverse sites with a history of excellence in CDS using the Rapid Assessment Process and analyzed the data using a series of card sorts, informed by Linstone's Multiple Perspectives Model.
  
  
  RESULTS
  We identified 18 activities and grouped them into four areas. Area 1: Fostering relationships across the organization, with activities (a) training and support, (b) visibility/presence on the floor, (c) liaising between people, (d) administration and leadership, (e) project management, (f) cheerleading/buy-in/sponsorship, (g) preparing for CDS implementation. Area 2: Assembling the system with activities (a) providing technical support, (b) CDS content development, (c) purchasing products from vendors (d) knowledge management, (e) system integration. Area 3: Using CDS to achieve the organization's goals with activities (a) reporting, (b) requirements-gathering/specifications, (c) monitoring CDS, (d) linking CDS to goals, (e) managing data. Area 4: Participation in external policy and standards activities (this area consists of only a single activity). We also identified a set of recommendations associated with these 18 activities.
  
  
  CONCLUSIONS
  All 18 activities we identified were performed at all sites, although the way they were organized into roles differed substantially. We consider these activities critical to the success of a CDS program.
  
  
  CONCLUSIONS
  A series of activities are performed by sites strong in CDS, and sites adopting CDS should ensure they incorporate these activities into their efforts.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Erickson
authors.forename: Joe
authors.initials: J
authors.lastname: Wasserman
authors.forename: Arwen
authors.initials: A
authors.lastname: Bunce
authors.forename: Ana
authors.initials: A
authors.lastname: Stanescu
authors.forename: Daniel
authors.initials: D
authors.lastname: St Hilaire
authors.forename: Morgan
authors.initials: M
authors.lastname: Panzenhagen
authors.forename: Eric
authors.initials: E
authors.lastname: Gebhardt
authors.forename: Carmit
authors.initials: C
authors.lastname: McMullen
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
mesh_terms: D003625:Data Collection; D003657:Decision Making; D020000:Decision Support Systems, Clinical / Q000458:organization & administration; D057286:Electronic Health Records; D006801:Humans; D007407:Interviews as Topic; D058436:Knowledge Management; D010564:Personnel, Hospital; D036301:Qualitative Research; D018511:Systems Integration; D000078329:Workforce
keywords: clinical decision support; governance; implementation; knowledge management; rapid assessment process