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Applying Clinical Decision Support Design Best Practices With the Practical Robust Implementation and Sustainability

Katy E Trinkley1,2,3,4, Miranda E Kroehl5, Michael G Kahn6

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|March 22, 2021
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Summary

Enhanced clinical decision support (CDS) tools, incorporating best practices and implementation science (IS) frameworks, significantly improve adoption and effectiveness compared to generic commercial options. This leads to better healthcare outcomes.

Keywords:
PRISMRE-AIMclinical decision support systemscongestive heart failureimplementation science

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Area of Science:

  • Health Informatics
  • Implementation Science
  • Clinical Decision Support Systems

Background:

  • Clinical decision support (CDS) adoption is hindered by a lack of user-centered design and resource-intensive best practices.
  • Commercially available CDS tools often fail to meet specific institutional needs due to generalized design.
  • Implementation science (IS) frameworks can guide the application of CDS best practices and improve reproducibility.

Purpose of the Study:

  • To compare the effectiveness of an enhanced CDS tool, informed by best practices and an IS framework, against a generic commercial CDS tool.

Main Methods:

  • A cluster randomized trial in 28 primary care clinics compared an IS-enhanced CDS alert with a commercial CDS alert for beta-blocker prescribing in heart failure.
  • The enhanced alert utilized the Practical, Robust, Implementation, and Sustainability Model (PRISM) IS framework, incorporating stakeholder input and environmental factors.
  • Mixed methods included a trial comparing adoption and prescribing changes, followed by interviews to explore clinician preferences.

Main Results:

  • The enhanced alert showed significantly higher adoption (62% vs. 29%) and effectiveness in changing prescribing behavior (14% vs. 0%) compared to the commercial alert.
  • The enhanced alert was used for more patients (61 vs. 26) and clinicians (87 vs. 31).
  • Most interviewed clinicians preferred the enhanced CDS alert.

Conclusions:

  • Applying CDS best practices guided by an IS framework enhances CDS tool implementation success over commercially available options.
  • User-centered design and consideration of contextual factors are crucial for effective CDS adoption.
  • IS frameworks offer a structured approach to developing and implementing impactful CDS interventions.