Identifying Best Practices for Clinical Decision Support and Knowledge Management in the Field

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Clinical decision support (CDS) provided through computerized provider order entry is essential to enhancing health care quality. Little research about CDS has been conducted in community hospitals. Because many problems with CDS are related to behavioral, organizational, and cognitive issues, the Provider Order Entry Team (POET) based at Oregon Health & Science University in Portland is conducting two multi-site studies about these issues, one in community hospitals and the other in ambulatory settings. The purpose is to identify best practices for CDS implementation and knowledge management. [1]


A series of ethnographic studies were conducted to gather information from nine diverse organizations. Using the Rapid Assessment Process methodology, surveys, interviews, and observations were conducted by a multi-disciplinary team over a period of two years in eight different geographic regions of the U.S.A. A template organizing method for an expedited analysis of the data was first utilized, followed by a deeper and more time consuming interpretive approach.


Five major categories of best practices that require careful consideration while carrying out the planning, implementation, and knowledge management processes related to CDS was identified.

  1. Best Practice 1: View CDS broadly/ define CDS broadly,
  2. Best Practice 2: Move forward with simple CDS no matter what your size,
  3. Best Practice 3: Focus on “inline” CDS. An inline CDS is that which notifies an intermediary such as a #nurse or pharmacist rather than a physician,
  4. Best Practice 4: Use what is available from your vendor but plan to customize the CDS,
  5. Best Practice 5: Plan knowledge management processes early.


The five best practices categories represented a high level view that can be useful to all types of organizations planning to implement CPOE with CDS. All of these best practices depend on planning ahead, ideally prior to CPOE implementation. All of the best practices also involved the availability of skilled informatics specialists and clinician leaders.


This is a good study that took the best practices for CDS and knowledge management from many pioneer organizations. Lessons learned through these pioneers can provide valuable guidance so that CDS can eventually have optimal impact on health care quality in many more organizations in the future.

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  1. Identifying Best Practices for Clinical Decision Support and Knowledge Management in the Field