Open Access Highly Accessed Research article

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

Joan S Ash1*, Dean F Sittig2, Kenneth P Guappone3, Richard H Dykstra1, Joshua Richardson4, Adam Wright567, James Carpenter3, Carmit McMullen8, Michael Shapiro1, Arwen Bunce1 and Blackford Middleton567

Author Affiliations

1 Oregon Health & Science University, Portland, OR, USA

2 University of Texas School of Biomedical Informatics, Houston, TX, USA

3 Providence Health Systems, Portland, OR, USA

4 Weill Cornell Medical College, New York, NY, USA

5 Brigham and Women's Hospital, Boston, MA, USA

6 Harvard Medical School, Boston, MA, USA

7 Partners HealthCare, Boston, MA, USA

8 Kaiser Permanente Center for Health Research, Portland, OR, USA

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BMC Medical Informatics and Decision Making 2012, 12:6  doi:10.1186/1472-6947-12-6

Published: 14 February 2012



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.