Clinical Decision Support Within the Regenstrief Medical Record System

2007 ◽  
pp. 190-214 ◽  
Author(s):  
Burke W. Mamlin ◽  
J. Marc Overhage ◽  
William Tierney ◽  
Paul Dexter ◽  
Clement J. McDonald
Keyword(s):  
Decision Support ◽  
Medical Record ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Record System ◽  
Medical Record System

scholarly journals Developing Clinical Decision Support within a Commercial Electronic Health Record System to Improve Antimicrobial Prescribing in the Neonatal ICU

2014 ◽  
Vol 05 (02) ◽  
pp. 368-387 ◽  
Author(s):  
K. Cato ◽  
B. Sheehan ◽  
S. Patel ◽  
J. Duchon ◽  
P. DeLaMora ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Electronic Health Record System ◽  
Health Record ◽  
Record System ◽  
Antimicrobial Prescribing ◽  
Neonatal Icu ◽  
Electronic Health

SummaryObjective: To develop and implement a clinical decision support (CDS) tool to improve antibiotic prescribing in neonatal intensive care units (NICUs) and to evaluate user acceptance of the CDS tool.Methods: Following sociotechnical analysis of NICU prescribing processes, a CDS tool for empiric and targeted antimicrobial therapy for healthcare-associated infections (HAIs) was developed and incorporated into a commercial electronic health record (EHR) in two NICUs. User logs were reviewed and NICU prescribers were surveyed for their perceptions of the CDS tool.Results: The CDS tool aggregated selected laboratory results, including culture results, to make treatment recommendations for common clinical scenarios. From July 2010 to May 2012, 1,303 CDS activations for 452 patients occurred representing 22% of patients prescribed antibiotics during this period. While NICU clinicians viewed two culture results per tool activation, prescribing recommendations were viewed during only 15% of activations. Most (63%) survey respondents were aware of the CDS tool, but fewer (37%) used it during their most recent NICU rotation. Respondents considered the most useful features to be summarized culture results (43%) and antibiotic recommendations (48%).Discussion: During the study period, the CDS tool functionality was hindered by EHR upgrades, implementation of a new laboratory information system, and changes to antimicrobial testing methodologies. Loss of functionality may have reduced viewing antibiotic recommendations. In contrast, viewing culture results was frequently performed, likely because this feature was perceived as useful and functionality was preserved.Conclusion: To improve CDS tool visibility and usefulness, we recommend early user and information technology team involvement which would facilitate use and mitigate implementation challenges.Citation: Hum RS, Cato K, Sheehan B, Patel S, Duchon J, DeLaMora P, Ferng YH, Graham P, Vawdrey DK, Perlman J, Larson E, Saiman L. Developing clinical decision support within a commercial electronic health record system to improve antimicrobial prescribing in the neonatal ICU. Appl Clin Inf 2014; 5: 368–387 http://dx.doi.org/10.4338/ACI-2013-09-RA-0069

scholarly journals The Use of Evidence-Based, Problem-Oriented Templates as a Clinical Decision Support in an Inpatient Electronic Health Record System

2016 ◽  
Vol 07 (03) ◽  
pp. 790-802 ◽  
Author(s):  
Nila Radhakrishnan ◽  
Carrie Warring ◽  
Ankur Jain ◽  
Jorge Fuentes ◽  
Angela Dolganiuc ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
Clinical Decision Support ◽  
Outcome Measurement ◽  
Clinical Decision ◽  
Electronic Health Record System ◽  
Evidence Based ◽  
Health Record ◽  
Record System ◽  
Electronic Health

SummaryThe integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied.We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices.This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs. Primary Outcome measurement was note quality, assessed by the 9-item Physician Documentation Quality Instrument (PDQI-9). Secondary Outcome measurement was physician efficiency, assessed by the total charting time per note.Use of POTs increased the quality of note documentation [score 37.5 vs. 39.0, P = 0.0020]. The benefits of POTs scaled with use; the greatest improvement in note quality was found in notes using three or more POTs [score 40.2, P = 0.0262]. There was no significant difference in total charting time [30 minutes vs. 27 minutes, P = 0.42].Use of evidence-based and problem-oriented templates is associated with improved note quality without significant change in total charting time. It can be used as an effective CDS during note documentation. Citation: Mehta R, Radhakrishnan NS, Warring CD, Jain A, Fuentes J, Dolganiuc A, Lourdes LS, Busigin J, Leverence RR. The use of evidence-based, problemoriented templates as a clinical decision support in an inpatient electronic health record system.

scholarly journals Impact of an Electronic Medical Record-Based Clinical Decision Support Tool for Dysphagia Screening on Care Quality

Stroke ◽  
2012 ◽  
Vol 43 (12) ◽  
pp. 3399-3401 ◽  
Author(s):  
Kamakshi Lakshminarayan ◽  
Nassir Rostambeigi ◽  
Candace C. Fuller ◽  
James M. Peacock ◽  
Albert W. Tsai
Keyword(s):  
Decision Support ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Care Quality ◽  
Support Tool ◽  
Clinical Decision Support Tool

scholarly journals Solving the interoperability challenge of a distributed complex patient guidance system: a data integrator based on HL7’s Virtual Medical Record standard

2015 ◽  
Vol 22 (3) ◽  
pp. 587-599 ◽  
Author(s):  
Carlos Marcos ◽  
Arturo González-Ferrer ◽  
Mor Peleg ◽  
Carlos Cavero
Keyword(s):  
Decision Support ◽  
Medical Record ◽  
Clinical Decision Support ◽  
Patient Information ◽  
Personal Health Record ◽  
Clinical Decision ◽  
Guidance System ◽  
Personal Health ◽  
Health Record ◽  
Patient Guidance

Abstract Objective We show how the HL7 Virtual Medical Record (vMR) standard can be used to design and implement a data integrator (DI) component that collects patient information from heterogeneous sources and stores it into a personal health record, from which it can then retrieve data. Our working hypothesis is that the HL7 vMR standard in its release 1 version can properly capture the semantics needed to drive evidence-based clinical decision support systems. Materials and Methods To achieve seamless communication between the personal health record and heterogeneous data consumers, we used a three-pronged approach. First, the choice of the HL7 vMR as a message model for all components accompanied by the use of medical vocabularies eases their semantic interoperability. Second, the DI follows a service-oriented approach to provide access to system components. Third, an XML database provides the data layer. Results The DI supports requirements of a guideline-based clinical decision support system implemented in two clinical domains and settings, ensuring reliable and secure access, high performance, and simplicity of integration, while complying with standards for the storage and processing of patient information needed for decision support and analytics. This was tested within the framework of a multinational project (www.mobiguide-project.eu) aimed at developing a ubiquitous patient guidance system (PGS). Discussion The vMR model with its extension mechanism is demonstrated to be effective for data integration and communication within a distributed PGS implemented for two clinical domains across different healthcare settings in two nations.

scholarly journals Guiding Glucose Management Discussions Among Adults With Type 2 Diabetes in General Practice: Development and Pretesting of a Clinical Decision Support Tool Prototype Embedded in an Electronic Medical Record

10.2196/17785 ◽  
2020 ◽  
Vol 4 (9) ◽  
pp. e17785
Author(s):  
Breanne E Kunstler ◽  
John Furler ◽  
Elizabeth Holmes-Truscott ◽  
Hamish McLachlan ◽  
Douglas Boyle ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Decision Support ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Clinical Decision Support ◽  
Pharmacological Treatment ◽  
Design Method ◽  
Clinical Decision ◽  
Treatment Intensification

Background Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options. Objective This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations. Methods The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification. Results Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities. Conclusions GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.

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