If healthcare providers are to succeed in incorporating clinical evidence into both the EHR and daily clinical care, they must adopt nimble decision-support tools that automatically trigger at a critical point in the clinical visit and include recommendations specific to the particular patient being seen.

That’s a tall but doable order, and its outcome largely lies in the level of research stakeholders are willing to support, according to a paper running in the Journal of Medical Internet Research.

Lead author Thomas McGinn, MD, MPH, of Hofstra University outlines a roadmap for providers to consider before setting out to integrate evidence-based decision support tools into the EHR.

The plan emphasizes three key action items:

• Appraisal of the quality of the evidence behind the decision support at hand;   
• Pre-integration assessment of usability and effect on workflow; and
• Evaluation of decision-support tools for their ability to perform and impact clinical care through assessments of providers’ perception of utility.

Poor adoption and sustainability of guidelines for evidence-based medicine and of tools for clinical decision support at the point of care “have persisted and continue to document low rates of usage,” the authors write.

They add that barriers frequently named by physicians include real or perceived negative impact on efficiency, usefulness, content, interface and over-triggering.

Which is where the research comes in—or needs to.

“Evaluation of the evidence and usability testing are often lacking in research design, implementation methodology and training of researchers in this area,” the authors write.

If the federal government, EHR vendors or healthcare institutions fail to support research in these areas, the integration of successful clinical decision support tools “will continue to lag in creating change in patient outcomes,” they conclude.

“At this critical juncture of widespread EHRs and pressure to bend the cost curve, incentives to help industry, government and academic health centers to support these research areas is urgent.”

The journal has posted the full paper.