Skip to main content

Table 1 CDS development and implementation challenges and strategies

From: Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care

Challenges

Strategies to address challenges

Communication, including terminology (clinical- versus informatics-based)

In person meetings with written decisions to create common understanding

Timeline to develop CDS

 

• Purchase and placement of hardware, privacy and ethical requirements

• Availability of researchers

• Simultaneous development of study database

• Privacy Impact Assessments

• Stakeholder engagement, proactive communication and collaboration

• Dedicated meeting times

• Minimize changes to dataset, update outstanding items during data cleaning

• Repeated stakeholder meetings, sought guidance from provincial experts

CDS integration

 

• Proprietary Electronic Medical Record (EMR) software prohibited integration

• Lack of access to “live feeds” of provincial data

• Lack of integration with provincial datasets for health outcomes data

• Study abstractors pre-populated the CDS with relevant historical data for consented patients

• Mimicked common EMR features in CDS (e.g., method to record medications)

• Utilized same login credentials for EMR and CDS where feasible

• Guided providers with minimum clinically relevant data to record in CDS

• Created workaround to copy study on labs (through use of secondary ‘mailbox’)

• Data gathering virtually where feasible, with in-person site visits when required

Slow Internet and CDS operating speeds

• Reduce backend platform features to improve reactivity

• Focused communications on key tasks (minimum user expectation)

Supporting intervention participants

• Pre-populated CDS with relevant historical data for consented patients

• Study office developed facile support tools (e.g., quick start guide), offered telephone support during office hours (8 am–4 pm)

• Hired “EMR Peer Champion” to lead training/illustrate how PCPs could integrate CDS into office work flow

• Focused communications on key tasks (minimum user expectation)

• Completed quarterly provider check-ins

• Created “How To” YouTube videos

• Communicated with patients on how to use Patient Care Partner tools