Integrating evidence into clinical information systems for nursing decision support

PURPOSE To illustrate approaches for providing decision support for evidence-based nursing practice through integration of evidence into clinical information systems (CISs) with examples from our experience at Columbia University Medical Center. ORGANIZING CONSTRUCT Examples are organized according to three types of decision support functions: information management, focusing attention, and patient-specific consultation. METHODS Three decision support tools that are integrated into three types of CISs are discussed: (1) infobuttons that provide context-specific access to digital sources of evidence; (2) automated Fall-Injury Risk Assessment; and (3) personal digital assistant-based screening reminders, screening assessments, and tailored documentation templates for the identification and management of obesity, depression, and tobacco cessation. The informatics infrastructure for implementing these decision support tools is described from the perspective of components identified in the published literature. CONCLUSIONS Efforts to facilitate application of evidence into nursing practice are unlikely to be successful unless the approaches used are integrated into the clinical workflow. Our approaches use a variety of informatics methods to integrate evidence into CISs as a mechanism for providing decision support for evidence-based practice in a manner consistent with nursing workflow.