Purpose or Case Report: The purpose of this study is to share our experience implementing a clinical decision support (CDS) solution for imaging at a quaternary care pediatric academic hospital.
Methods & Materials: Over the course of 16 months we implemented a clinical decision support system into our EHR. To improve adoption and maintain system stability we conducted the implementation in a step-wise manner. 6 different phases were employed: Planning, Building, Testing, Silent mode activation, Data Analysis, and Full operationalization. Each phase brought challenges and opportunities.
Results: Establishing a multi-disciplinary team of leaders from both within and external to Radiology prior to embarking on the project is essential. Customizing the product for a particular institution is a labor intensive process which requires individuals who are both technically savvy and have medical knowledge. Organizing focus groups of users to test the system prior to activation enhances the system by improving trust and buy-in. One of the biggest adjustments in using a CDS is the culture change from allowing free text indications to relying on structured indications; there will be late adopters not accepting the appropriateness criteria but they will be in the minority. Initially operating the product in the background without interrupting workflows encourages providers to experiment with the system and provides important data on ordering habits and usage. Data analysis is essential to iteratively improve the user experience and provide data driven feedback to providers and executives, whom are interested in both the clinical and financial aspects of the system. Full operationalization of the CDS requires a coordinated effort by physician leaders, administrators and information services to successfully implement.
Conclusions: Keys to successfully implementing a CDS system at a pediatric academic hospital include building a motivated multi-disciplinary team, anticipating the unexpected, and establishing strong communication with ordering providers and executives. The experience at our hospital can help other pediatric hospitals seeking to implement a CDS system.