Analysis of Nursing Clinical Decision Support Requests and Strategic Plan in a Large Academic Health System
07 October 2015
accepted: 01 February 2016
16 December 2017 (online)
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.
Materials and Methods
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.
- 1 Osheroff JA, Teich JM, Middleton B, Steen EB, Wright A, Detmer DE. A roadmap for national action on clinical decision support. J Am Med Inf Assoc 2007; 14 (02) 141-145 doi:10.1197/jamia.M2334.
- 2 Centers for Mediacare & Medicaid Services (CMS). US Deparment of Health and Human Services. EHR Incentive Programs, Clinical Decision Support. http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalDecisionSupport_Tipsheet-.pdf Accessed May, 9 2015.
- 3 Kawamoto K, Lobach D, Willard H, Ginsburg G. A national clinical decision support infrastructure to enable the widespread and consistent practice of genomic and personalized medicine. BMC Med Inform Decis Mak 2009; 09: 17 doi: 10.1186/1472–6947–9–17.
- 4 Hongsermeier T, Kashyap V, Sordo M. In: Clinical Decision Support: the Road Ahead. Greenes RA. editor Boston: Elsevier Academic Press; 2007. Knowledge management infrastructure: evaluation at Partners HealthCare System. 447-467.
- 5 Bakken S, Currie LM, Lee N-J, Roberts WD, Collins S, Cimino JJ. Integrating evidence into clinical information systems for nursing decision support. Int J Med Inf 2008; 77 (06) 413-420 doi:10.1016/j.ijmedinf.2007.08.006.
- 6 Sim I, Gorman P, Greenes RA, Haynes RB, Kaplan B, Lehmann H, Tang PC. Clinical decision support systems for the practice of evidence-based medicine. J Am Med Inform Assoc 2001; 08 (06) 527-534.
- 7 Anderson J, Wilson P. Clinical decision support systems in nursing synthesis of the science for evidencebased practice. Computers, Informatics, Nursing 2008; 26 (03) 151-158.
- 8 Matney S, Brewster PJ, Sward KA, Cloyes KG, Staggers N. Philosophical approaches to the nursing informatics data-information-knowledge-wisdom framework. Adv Nurs Sci 2011; 34 (01) 6-18 doi:10.1097/ANS.0b013e3182071813.
- 9 Nursing Informatics. Scope and Standards of Practice. Silver Spring, MD: American Nurses Association (ANA); 2008. 01 177.
- 10 Lagor C. The Clinical Decision Support Life-Cycle. Retrieved from http://s3.amazonaws.com/rdcms-himss/files/production/public/2015Conference/handouts/96_1428607926574_4.pdf>
- 11 Centers for Mediacare & Medicaid Services (CMS). US Deparment of Health and Human Services. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_6_ClinicalDecisionSupport.pdf Accessed May, 9 2015.
- 12 Maviglia S, Sordo M. Practical approaches to knowledge management: Focus on clinical decision support. MEDINFO 2015. Proceedings of the 15th World Congress on Health (Medical) Informatics; 2015 Aug 19-23. Sao Paulo, Brazil: http://medinfo2015.com/wpcontent/uploads/2015/06/Practical-Approaches-to- Knowledge-Management-Focus-on-Clinical-Decision-Support.pdf
- 13 Xiang S, Bouyer-Ferullo S, Lagor C, Maviglia S, Yoshida E. The evolution of a clinical decision support request form. American Medical Informatics Association. 2015
- 14 Dowding D. et al. International priorities for research in nursing informatics for patient care. Stud Health Technol Inform 2013; 192: 372-376.
- 15 Bouyer-Ferullo S, Androwich I, Dykes P. Clinical decision support and perioperative peripheral nerve injury: A quality improvement project. CIN: Computers, Informatics, Nursing 2015; 33 (06) 238-248 doi:10.1097/CIN.00000000000148.
- 16 Benner P. The wisdom of our practice. The American Journal of Nursing 2000; 100 (10) 99-105.
- 17 Courtney K, Alexander G, Demiris G. Information technology from novice to expert: implementation implications. Journal of Nursing Management 2008; 16: 692-699.