title: Multiple perspectives on clinical decision support: a qualitative study of fifteen clinical and vendor organizations.
abstract: BACKGROUND
  Computerized clinical decision support (CDS) can help hospitals to improve healthcare. However, CDS can be problematic. The purpose of this study was to discover how the views of clinical stakeholders, CDS content vendors, and EHR vendors are alike or different with respect to challenges in the development, management, and use of CDS.
  
  
  METHODS
  We conducted ethnographic fieldwork using a Rapid Assessment Process within ten clinical and five health information technology (HIT) vendor organizations. Using an inductive analytical approach, we generated themes from the clinical, content vendor, and electronic health record vendor perspectives and compared them.
  
  
  RESULTS
  The groups share views on the importance of appropriate manpower, careful knowledge management, CDS that fits user workflow, the need for communication among the groups, and for mutual strategizing about the future of CDS. However, views of usability, training, metrics, interoperability, product use, and legal issues differed. Recommendations for improvement include increased collaboration to address legal, manpower, and CDS sharing issues.
  
  
  CONCLUSIONS
  The three groups share thinking about many aspects of CDS, but views differ in a number of important respects as well. Until these three groups can reach a mutual understanding of the views of the other stakeholders, and work together, CDS will not reach its potential.
authors.affiliation: Oregon Health & Science University, Portland, OR, USA. ash@ohsu.edu.
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.affiliation: University of Texas School of Biomedical Informatics, Houston, TX, USA.
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, OR, USA.
authors.forename: Carmit K
authors.initials: CK
authors.lastname: McMullen
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Partners HealthCare, Boston, MA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, OR, USA.
authors.forename: Arwen
authors.initials: A
authors.lastname: Bunce
authors.affiliation: Oregon Health & Science University, Portland, OR, USA.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Mohan
authors.affiliation: Oregon Health & Science University, Portland, OR, USA.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Vanderbilt University, Nashville, TN, USA.
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D000328:Adult; D020000:Decision Support Systems, Clinical / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D006801:Humans; D058436:Knowledge Management; D036301:Qualitative Research