How to Develop and Implement a Computerized Decision Support System Integrated for Antimicrobial Stewardship? Experiences From Two Swiss Hospital Systems
| Autor: | Gaud Catho, Nicolo S. Centemero, Brigitte Waldispühl Suter, Nathalie Vernaz, Javier Portela, Serge Da Silva, Roberta Valotti, Valentina Coray, Francesco Pagnamenta, Alice Ranzani, Marie-Françoise Piuz, Luigia Elzi, Rodolphe Meyer, Enos Bernasconi, Benedikt D. Huttner, The COMPASS Study Group |
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| Rok vydání: | 2021 |
| Předmět: |
Decision support system
Process management 020205 medical informatics Computer science cluster randomized controlled trial lcsh:Medicine Context (language use) 02 engineering and technology Clinical decision support system lcsh:QA75.5-76.95 usability testing 03 medical and health sciences 0302 clinical medicine 0202 electrical engineering electronic engineering information engineering Antimicrobial stewardship 030212 general & internal medicine implementation user training computerized decision support system business.industry End user lcsh:Public aspects of medicine lcsh:R Information technology lcsh:RA1-1270 Usability Digital health antimicrobial stewardship Perspective Digital Health lcsh:Electronic computers. Computer science business multidisciplinary |
| Zdroj: | Frontiers in Digital Health Frontiers in Digital Health, Vol 2 (2021) |
| ISSN: | 2673-253X |
| DOI: | 10.3389/fdgth.2020.583390 |
| Popis: | Background: Computerized decision support systems (CDSS) provide new opportunities for automating antimicrobial stewardship (AMS) interventions and integrating them in routine healthcare. CDSS are recommended as part of AMS programs by international guidelines but few have been implemented so far. In the context of the publicly funded COMPuterized Antibiotic Stewardship Study (COMPASS), we developed and implemented two CDSSs for antimicrobial prescriptions integrated into the in-house electronic health records of two public hospitals in Switzerland. Developing and implementing such systems was a unique opportunity for learning during which we faced several challenges. In this narrative review we describe key lessons learned.Recommendations: (1) During the initial planning and development stage, start by drafting the CDSS as an algorithm and use a standardized format to communicate clearly the desired functionalities of the tool to all stakeholders. (2) Set up a multidisciplinary team bringing together Information Technologies (IT) specialists with development expertise, clinicians familiar with “real-life” processes in the wards and if possible, involve collaborators having knowledge in both areas. (3) When designing the CDSS, make the underlying decision-making process transparent for physicians and start simple and make sure to find the right balance between force and persuasion to ensure adoption by end-users. (4) Correctly assess the clinical and economic impact of your tool, therefore try to use standardized terminologies and limit the use of free text for analysis purpose. (5) At the implementation stage, plan usability testing early, develop an appropriate training plan suitable to end users' skills and time-constraints and think ahead of additional challenges related to the study design that may occur (such as a cluster randomized trial). Stay also tuned to react quickly during the intervention phase. (6) Finally, during the assessment stage plan ahead maintenance, adaptation and related financial challenges and stay connected with institutional partners to leverage potential synergies with other informatics projects. |
| Databáze: | OpenAIRE |
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