title: Analysis of Nursing Clinical Decision Support Requests and Strategic Plan in a Large Academic Health System.
abstract: To understand requests for nursing Clinical Decision Support (CDS) interventions at a large integrated health system undergoing vendor-based EHR implementation. In addition, to establish a process to guide both short-term implementation and long-term strategic goals to meet nursing CDS needs.
  
  
  
  We conducted an environmental scan to understand current state of nursing CDS over three months. The environmental scan consisted of a literature review and an analysis of CDS requests received from across our health system. We identified existing high priority CDS and paper-based tools used in nursing practice at our health system that guide decision-making.
  
  
  
  A total of 46 nursing CDS requests were received. Fifty-six percent (n=26) were specific to a clinical specialty; 22 percent (n=10) were focused on facilitating clinical consults in the inpatient setting. "Risk Assessments/Risk Reduction/Promotion of Healthy Habits" (n=23) was the most requested High Priority Category received for nursing CDS. A continuum of types of nursing CDS needs emerged using the Data-Information-Knowledge-Wisdom Conceptual Framework: 1) facilitating data capture, 2) meeting information needs, 3) guiding knowledge-based decision making, and 4) exposing analytics for wisdom-based clinical interpretation by the nurse.
  
  
  
  Identifying and prioritizing paper-based tools that can be modified into electronic CDS is a challenge. CDS strategy is an evolving process that relies on close collaboration and engagement with clinical sites for short-term implementation and should be incorporated into a long-term strategic plan that can be optimized and achieved overtime. The Data-Information-Knowledge-Wisdom Conceptual Framework in conjunction with the High Priority Categories established may be a useful tool to guide a strategic approach for meeting short-term nursing CDS needs and aligning with the organizational strategic plan.
authors.affiliation: Massachusetts General Hospital, Boston, MA; University of Colorado Denver, Denver, CO.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Whalen
authors.affiliation: Partners Healthcare System , Wellesley, MA.
authors.forename: Karen
authors.initials: K
authors.lastname: Bavuso
authors.affiliation: Partners Healthcare System , Wellesley, MA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Bouyer-Ferullo
authors.affiliation: Brigham and Women's Hospital , Boston, MA.
authors.forename: Denise
authors.initials: D
authors.lastname: Goldsmith
authors.affiliation: Partners Healthcare System , Wellesley, MA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Fairbanks
authors.affiliation: Partners Healthcare System , Wellesley, MA.
authors.forename: Emily
authors.initials: E
authors.lastname: Gesner
authors.affiliation: Partners Healthcare System , Wellesley, MA.
authors.forename: Charles
authors.initials: C
authors.lastname: Lagor
authors.affiliation: Partners Healthcare System, Wellesley, MA; Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Collins
mesh_terms: D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D006801:Humans; D009729:Nursing / Q000379:methods*
keywords: Electronic health records; clinical decision support; evidence-based nursing; hospital information systems; nursing informatics