Introduction
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PROLIFERATION
With the proliferation of health care data, an overwhelming amount of information could be made available as robust clinical decision support (CDS) for clinicians in a genuinely helpful format. Despite the length of time that electronic health records (EHRs) have been around, there continue to be reports of unintended consequences from poor design and inadequate testing [A systematic review of 28 studies targeting hospital nurses’ decision-making underscored the promise of CDS, including improved care processes in 7 out of 7 studies, improved usability in 4 out of 4 studies, and improved patient outcomes in 3 out of 4 studies [In a study of visual data displays in 2 homecare facilities, nurses understood graphs most easily, followed by tables, line graphs, and spider graphs. Furthermore, nurses with low numeracy and GL had poorer comprehension of the information displayed across all formats. High GL appeared to enhance the comprehension of data regardless of numeracy [In our prior laboratory-based preclinical simulation RCT, also funded by the National Institute of Nursing Research, we compared the care planning time (CPT) and rates of selecting evidence-based best practice nursing diagnoses, interventions, and outcomes for RNs. The 60 RNs were randomly assigned to 1 of 4 different CDS format conditions: text only (TO), text+table (TT), text+graph (TG), or no CDS [The primary aim of our nationally representative, web-based simulation RCT reported here was to examine the effects of tailoring (ie, assigning RNs to a format type based on GL) by comparing 203 RNs randomly assigned with CDS format groups (TO, TT, TG, and tailored) on CPT and the adoption of evidence-based best practices. We hypothesized that the tailored CDS group would have faster CPT (primary) and higher CDS recommendation adoption rates. This study is part of our team’s larger research agenda focused on generating standardized nursing data gathered in EHRs, automatically analyzing these data, and returning relevant evidence to the point of care in a CDS format supporting efficient and effective RN decisions. This study is part of a research agenda that began in 1998 with the creation of a research-based nurse care planning system. A synopsis of the team’s work to date is shown in History of HANDS (Hands-on Automated Nursing Data System) research [