JMIR Publications

ABSTRACT

Background:

CDS design best practices are intended to provide a narrative representation of factors that influence the success of CDS tools. However, they provide incomplete direction on evidence-based implementation principles.

Objective:

The objective of this study was to describe an integrated approach to apply an existing implementation science framework with CDS design best practices to improve effectiveness, sustainability and reproducibility of CDS implementations.

Methods:

Of the implementation science frameworks, we selected the Practical Robust Implementation and Sustainability Model (PRISM). We identified areas where PRISM and CDS design best practices complement each other and defined methods to address each. Lessons learned from applying these methods were then used to further refine the integrated approach.

Results:

Our integrated approach to applying PRISM with CDS design best practices consists of five key phases which iteratively interact and inform each other: 1) multilevel stakeholder engagement, 2) designing the CDS, 3) design and usability testing, 4) thoughtful deployment, and 5) performance evaluation and maintenance. The approach is led by a dedicated implementation team which includes clinical informatics and analyst builder expertise.

Conclusions:

Integrating PRISM with CDS design best practices extends user-centered design and accounts for the multilevel, interacting and dynamic factors that influence CDS implementation in healthcare. Integrating PRISM with CDS design best practices synthesizes the many known contextual factors that can influence the success of CDS tools, thereby enhancing the reproducibility and sustainability of CDS implementations. Others can adapt this approach for their situation to maximize and sustain CDS implementation success.