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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Medical Informatics and Decision Making 1/2012

Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

BMC Medical Informatics and Decision Making > Ausgabe 1/2012
Joan S Ash, Dean F Sittig, Kenneth P Guappone, Richard H Dykstra, Joshua Richardson, Adam Wright, James Carpenter, Carmit McMullen, Michael Shapiro, Arwen Bunce, Blackford Middleton
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6947-12-6) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

JSA, DFS, AW, and CM designed and conducted the study, analyzed the data, and wrote the paper. KPG, RHD, JR, JC, AB and MS assisted in the design of the study, gathered and analyzed the data, and reviewed versions of the manuscript. AB also organized the data and contributed significantly to writing the paper. BM, with JSA, obtained funding for the study and reviewed and revised drafts of the manuscript. All authors except RHD, now deceased, have read and approved the final manuscript.



The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S.


Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices.


The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction.


These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.
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