: Clinical decision support is key to computerized provider order entry success and safer, more efficient health care. Research at leading academic health centers indicates that when computerized provider order entry (CPOE) is coupled with clinical decision support (CDS), medical errors may decrease and costs drop. However, CPOE with CDS is not used in most community hospitals, which account for approximately 96% of all U.S. hospitals. This gap in CDS implementation between community and teaching hospitals portends serious consequences for health care quality, patient safety, and rising costs. This revised two-year proposal outlines three aims for investigating CDS in community hospitals and collecting and disseminating knowledge about what does and does not work. Research questions are 1) What are barriers to and facilitators for use of different types of CDS in community hospital settings? 2) What strategies have community hospitals and clinics used to lessen the barriers and strengthen the facilitators? Our specific aims are as follows: AIM1. Identify the barriers/facilitators to CDS at three community hospitals and associated clinics. Our multidisciplinary team will visit three purposively-selected, geographically-distributed community hospital settings that have a range of commercially-available CPOE systems with CDS. We will gather data using a mixed methods approach we call the Rapid Assessment Process, employing a unique combination of qualitative and quantitative methods to gain deep insight into and understanding of CDS issues. AIM 2. Validate the barriers and facilitators to CDS use identified in these community settings with help from a group of CDS experts. During a two-day retreat, an expert panel of clinical and administrative leaders representing hospitals with CDS, hospital information systems vendors, clinical knowledge management vendors, and informatics will review and enhance the results of our fieldwork and plan strategies for translating this knowledge into practice. AIM 3. Document the breadth and depth of CDS usage nationally, identify strategies hospitals have used to improve their CDS planning, implementing, monitoring, and modification over time, translate this knowledge into actionable recommendations, and disseminate results. Based on the results of Aims 1 and 2, we will develop, test, and refine a series of questions culminating in a telephone survey, which we will administer to a sample of U.S. hospitals with and without CDS. This semi-structured survey will explore the extent and use of CDS at community hospitals and help us learn how they have addressed various barriers and facilitators to CDS. Following a knowledge translation process, we will disseminate recommendations via the Web, publications, and direct communication to community hospitals. By producing actionable recommendations for CDS design, implementation, evaluation, and national policy development, we aim to maximize the ability of U.S. hospitals to Increase quality, safety and efficiency benefits from CPOE with CDS.