Measuring implementation feasibility of clinical decision support alerts for clinical practice recommendations

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Electronic Health Records

Background:

• Clinical practice recommendations are crucial for evidence-based care.
• Translating these recommendations into electronic health record (EHR)-embedded clinical decision support (CDS) tools presents implementation challenges.

Purpose of the Study:

• To identify key features of clinical concepts and data needed for CDS implementation.
• To determine which recommendation characteristics predict the feasibility of implementing CDS tools.

Main Methods:

• Semistructured interviews were conducted with CDS implementers and clinical experts at seven academic medical centers.
• Feasibility of implementing 10 American College of Emergency Physicians Choosing Wisely Recommendations as EHR-embedded CDS was rated.
• A predictive model for technical implementation feasibility was developed using guideline features and expert ratings.

Main Results:

• The need for new data collection was a significant predictor of lower implementation feasibility.
• The number of clinical concepts, need for historical data, and concept ambiguity did not predict implementation feasibility.

Conclusions:

• Data availability and the requirement for additional data collection are critical for assessing CDS implementation feasibility.
• Authors of practice recommendations should include operational definitions for required data to streamline feasibility assessments.