Publikationsdatum:
2012-08-18
Beschreibung:
Background: Greater use of computerized decision support (DS) systems could address continuing safetyand quality problems in healthcare, but the healthcare field has struggled to implement DStechnology. This study surveys DS experience across multiple non-healthcare disciplines fornew insights that are generalizable to healthcare provider decisions. In particular, it soughtdesign principles and lessons learned from the other disciplines that could inform efforts toaccelerate the adoption of clinical decision support (CDS). Methods: Our systematic review drew broadly from non-healthcare databases in the basic sciences,social sciences, humanities, engineering, business, and defense: PsychINFO, BusinessSourcePremier, Social Sciences Abstracts, Web of Science, and Defense Technical InformationCenter. Because our interest was in DS that could apply to clinical decisions, we selectedarticles that (1) provided a review, overview, discussion of lessons learned, or an evaluationof design or implementation aspects of DS within a non-healthcare discipline and (2)involved an element of human judgment at the individual level, as opposed to decisions thatcan be fully automated or that are made at the organizational level. Results: Clinical decisions share some similarities with decisions made by military commanders,business managers, and other leaders: they involve assessing new situations and choosingcourses of action with major consequences, under time pressure, and with incompleteinformation. We identified seven high-level DS system design features from the nonhealthcareliterature that could be applied to CDS: providing broad, system-levelperspectives; customizing interfaces to specific users and roles; making the DS reasoningtransparent; presenting data effectively; generating multiple scenarios covering disparateoutcomes (e.g., effective; effective with side effects; ineffective); allowing for contingentadaptations; and facilitating collaboration. The article provides examples of each feature. TheDS literature also emphasizes the importance of organizational culture and training inimplementation success. The literature contrasts "rational-analytic" vs. "naturalistic-intuitive"decision-making styles, but the best approach is often a balanced approach that combinesboth styles. It is also important for DS systems to enable exploration of multiple assumptions,and incorporation of new information in response to changing circumstances. Conclusions: Complex, high-level decision-making has common features across disciplines as seeminglydisparate as defense, business, and healthcare. National efforts to advance the healthinformation technology agenda through broader CDS adoption could benefit by applying theDS principles identified in this review.
Digitale ISSN:
1472-6947
Thema:
Informatik
,
Medizin
Permalink