Lessons Learned

This chapter discusses aspects of the experiences with clinical decision support (CDS) to identify factors instrumental to success and those that have held back replication of demonstrated successes. Most of the innovation in this realm has come from academic sites, rather than from commercial systems. Some movement of academically validated approaches into commercial systems has indeed occurred, and the offerings of commercial systems are gaining momentum. However, commercial vendors have tended to be cautious and deliberately introduced CDS functionality into their markets, to be sure that their customers are prepared for and want it. An inertial process is at play with respect to the diffusion and adoption of CDS, but there may be a number of additional technical, organizational, and sociocultural factors in this sphere of activity in which use of information technology is actually quite a disruptive innovation that requires pervasive changes in the way people do their jobs and even think about their jobs. Dissemination of CDS must overcome differences in system platforms, design, and functionality. Adoption must rely not only on incorporation of the methodology, but acceptance or adaptation of the knowledge content of CDS-involving at least two of the three life cycle processes. The chapter further discusses the generic issues, specific characteristics of the sites of innovation, and approaches impeding diffusion.