Goldstein MK et al. 2004 "Translating research into practice: organizational issues in implementing automated decision support for hypertension in three medical centers."
Goldstein MK, Coleman RW, Tu SW, et al. Translating research into practice: organizational issues in implementing automated decision support for hypertension in three medical centers. J Am Med Inform Assoc 2004;11(5):368-376.
"Information technology can support the implementation of clinical research findings in practice settings. Technology can address the quality gap in health care by providing automated decision support to clinicians that integrates guideline knowledge with electronic patient data to present real-time, patient-specific recommendations. However, technical success in implementing decision support systems may not translate directly into system use by clinicians. Successful technology integration into clinical work settings requires explicit attention to the organizational context. We describe the application of a "sociotechnical" approach to integration of...a decision support system for the treatment of hypertension, into geographically dispersed primary care clinics. We applied an iterative technical design in response to organizational input and obtained ongoing endorsements of the project by the organization's administrative and clinical leadership. Conscious attention to organizational context at the time of development, deployment, and maintenance of the system was associated with extensive clinician use of the system."
To "describe the application of a 'sociotechnical' approach to integration of...a decision support system for the treatment of hypertension, into geographically dispersed primary care clinics."
The decision support system (DSS) was studied at three Veterans Administration medical centers: VA Palo Alto Health Care System (VAPAHCS), San Francisco VA Medical Center, and Durham VA Medical Center. VAPACHS encompasses both a tertiary-care hospital as well as a network of clinics that were included in the study, located in the following cities in California: Palo Alto, Menlo Park, San Jose, Monterey, Capitola, Livermore, Stockton, and Modesto.
Type of Health IT
Decision support system
Type of Health IT Functions
"The intervention is a decision support system for hypertension that automates evidence-based guidelines for management of primary hypertension. It uses a guideline interpreter to combine patient information from the [electronic medical record] EMR with knowledge of hypertension to generate patient-specific recommendations, explanations, and evidence-based education, which are then delivered to clinicians in a pop-up window at the time of outpatient primary care clinic visits." "The system is intended to be platform-independent and integrate into existing legacy systems." The system was designed to integrate smoothly into the clinicians' workflow. Recommendations "appear at the time of clinical decision making, without requiring further action by the clinician, [and] advisories appear to the clinician in the CPRS-GUI coversheet as a pop-up window when an appropriate patient record is accessed." Generating "recommendations [does] not require that the clinician retype data known to the system." After updated information is entered, the system "return[s] a nearly instantaneous update of recommendations." The system does "not slow down workstation performance." Users can "bypass the pop-up window easily if they do not want to use it," and "the system [runs] on the existing operating system."
Context or other IT in place
Electronic health records (EHR)
In order to keep physicians interested in using the hypertension DSS despite the number of clinical reminders they receive, the system provided quarterly feedback on guideline-drug concordance for hypertension. "Presenting [physicians] with their medical center's and their individual rates of adequacy of control of blood pressure appeared to sustain interest [in the project]."
"We also have good indications that the advisories have captured the clinicians' interest. The clinicians are interacting with the displayed advisories at a very substantial rate. These time-pressured clinicians, who are generally fully booked in clinics with complex patients, entered hundreds of free-text comments suggesting their interest in the system."
Participants were physicians working in the primary care clinics of the three medical centers.