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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