Translating Research into Practice: Organizational Issues in Implementing Automated Decision Support for Hypertension in Three Medical Centers

Abstract

Information technology can support the implementation of clinical research findings in practice settings. Technology can address the quality gap in health care by providing automated decision support to clinicians that integrates guideline knowledge with electronic patient data to present real-time, patient-specific recommendations. However, technical success in implementing decision support systems may not translate directly into system use by clinicians. Successful technology integration into clinical work settings requires explicit attention to the organizational context. We describe the application of a "sociotechnical" approach to integration of ATHENA DSS, a decision support system for the treatment of hypertension, into geographically dispersed primary care clinics. We applied an iterative technical design in response to organizational input and obtained ongoing endorsements of the project by the organization's administrative and clinical leadership. Conscious attention to organizational context at the time of development, deployment, and maintenance of the system was associated with extensive clinician use of the system.

Treatment Intensification in a Hypertension Telemanagement Trial

“…Next, the study nurse provided the study physician with all home BP measurements, medication lists, pharmacy refill information, relevant self-reported information, and any medication change recommendations generated by a clinical decision support system. 21 The study physician reviewed this information, as well as recent data from the patient's electronic medical chart, and decided whether to intensify the hypertension regimen. When treatment intensification was enacted, the study nurse contacted patients 3 weeks after the medication change to ascertain adverse effects and address patient questions.…”

Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program

“…14 The study physician reviewed the patient's BP, medication, and adherence (based on patient report and prescription refill data) with the nurse and decided whether to change hypertension medication. 15 The nurse communicated recommended changes to the patient, while the study physician electronically prescribed the medication and generated a note in the patient's medical record that was co-signed by the patient's primary care provider.…”

Behavioral medicine perspectives on the design of health information technology to improve decision-making, guideline adherence, and care coordination in chronic pain management

“…The ATHENA-OT system is based on an earlier CDS, ATHENA-hypertension, which was developed to improve the management of hypertension in primary care and has been disseminated to other VA health care facilities for study in two multisite randomized control trials [17,18]. A more comprehensive description of the development process can be found in a recent publication [19].…”