The Anatomy of Decision Support During Inpatient Care Provider Order Entry (CPOE): Empirical Observations from a Decade of CPOE Experience at Vanderbilt.

The authors describe a pragmatic approach to the introduction of clinical decision support at the point of care, based on a decade of experience in developing and evolving Vanderbilt's inpatient "WizOrder" care provider order entry (CPOE) system. The inpatient care setting provides a unique opportunity to interject CPOE-based decision support features that restructure clinical workflows, deliver focused relevant educational materials, and influence how care is delivered to patients. The specific approach to implementing a given clinical decision support feature within a CPOE system should involve evaluation along three axes: what type of intervention to create; when to introduce the intervention into the user's workflow; and how disruptive, during use of the system, the intervention might be to end-users' workflows. Framing decision support in this manner may help both developers and clinical end-users plan future alterations to their systems when needs for new decision support features arise.