Evaluating clinical decision support rules as an intervention in clinician workflows with technology

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Rural Healthcare

Background:

• Implementing electronic health records (EHRs) in rural settings presents unique challenges compared to urban hospitals.
• Effective preparation, implementation, and sustainment of clinical decision support (CDS) rules require careful consideration of standards, design, resources, and expertise.

Purpose of the Study:

• To present the progress and evolution of CDS rule implementation and use within clinician workflows in a rural hospital's EHR.
• To describe tools for validating CDS rules and demonstrate their successful application in a rural referral hospital and associated clinics.

Main Methods:

• A formative evaluation approach was employed to assess the implementation and use of CDS rules.
• Tools were developed to validate an initial set of 54 CDS rules for the hospital and 17 for clinics.
• The study leveraged existing CDS rules from urban hospitals within the same system.

Main Results:

• The rural hospital successfully adopted and utilized CDS rules from urban counterparts, enhancing safety, error prevention, evidence-based practices, and communication.
• Specific CDS rules for conditions like catheter-acquired urinary tract infections, deep venous thrombosis, and heart failure were implemented.
• Findings confirmed the validity of using CDS rules across different sites and the efficacy of existing indicators for outcome measurement.

Conclusions:

• Rural hospitals can overcome barriers to EHR CDS rule implementation and sustainment through a systemized approach and robust support structures.
• A model for designing and validating CDS rules within workflow processes is presented.
• Replication and reuse of CDS rule templates can facilitate their adoption in other rural and critical access hospitals.