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|Title||Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma.|
|Publication Type||Journal Article|
|Year of Publication||2016|
|Authors||Goldberg HS, Paterno MD, Grundmeier RW, Rocha BH, Hoffman JM, Tham E, Swietlik M, Schaeffer MH, Pabbathi D, Deakyne SJ, Kuppermann N, Dayan PS|
|Journal||Int J Med Inform|
|Date Published||2016 Mar|
|Keywords||Adolescent, Brain Injuries, Case Management, Child, Child, Preschool, Decision Support Systems, Clinical, Electronic Health Records, Emergency Service, Hospital, Female, Humans, Infant, Infant, Newborn, Male, Remote Consultation|
OBJECTIVE: To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma.
MATERIALS AND METHODS: We integrated the Epic(®) electronic health record (EHR) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments. Patterns of CDS review included either a delayed, near-real-time review, where the physician viewed CDS recommendations generated by the nursing assessment, or a real-time review, where the physician viewed recommendations generated by their own documentation. A backstopping, vendor-based CDS triggered with zero delay when no recommendation was available in the EHR from the web-service. We assessed the execution characteristics of the integrated system and the source of the generated recommendations viewed by physicians.
RESULTS: The ECRS mean execution time was 0.74 ±0.72 s. Overall execution time was substantially different at the two sites, with mean total transaction times of 19.67 and 3.99 s. Of 1930 analyzed transactions from the two sites, 60% (310/521) of all physician documentation-initiated recommendations and 99% (1390/1409) of all nurse documentation-initiated recommendations originated from the remote web service.
DISCUSSION: The remote CDS system was the source of recommendations in more than half of the real-time cases and virtually all the near-real-time cases. Comparisons are limited by allowable variation in user workflow and resolution of the EHR clock.
CONCLUSION: With maturation and adoption of standards for CDS services, remote CDS shows promise to decrease time-to-trial for multicenter evaluations of candidate decision support interventions.
|Alternate Journal||Int J Med Inform|
|Grant List||S02MC19289-01-00 / / PHS HHS / United States |
U03MC00001 / / PHS HHS / United States
U03MC00003 / / PHS HHS / United States
U03MC00006 / / PHS HHS / United States
U03MC00007 / / PHS HHS / United States
U03MC00008 / / PHS HHS / United States
U03MC22684 / / PHS HHS / United States
U03MC22685 / / PHS HHS / United States