Thomas McGinn1, David A Feldstein2, Isabel Barata3, Emily Heineman4, Joshua Ross2, Dana Kaplan3, Safiya Richardson3, Barbara Knox5, Amanda Palm2, Francesca Bullaro3, Nicholas Kuehnel2, Linda Park2, Sundas Khan3, Benjamin Eithun2, Rachel P Berger6. 1. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States; Baylor College of Medicine, Houston, Texas, United States. 2. University of Wisconsin School of Medicine and Public Health, Madison, WI, United States. 3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States. 4. Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States. 5. Children's Hospital at Providence/Alaska Child Abuse Response and Evaluation Services, United States; University of Washington, Seattle, Washington, United States. 6. Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States. Electronic address: rachel.berger@chp.edu.
Abstract
BACKGROUND: Child maltreatment is a leading cause of pediatric morbidity and mortality. We previously reported on development and implementation of a child abuse clinical decision support system (CA-CDSS) in the Cerner electronic health record (EHR). Our objective was to develop a CA-CDSS in two different EHRs. METHODS: Using the CA-CDSS in Cerner as a template, CA-CDSSs were developed for use in four hospitals in the Northwell Health system who use Allscripts and two hospitals in the University of Wisconsin health system who use Epic. Each system had a combination of triggers, alerts and child abuse-specific order sets. Usability evaluation was done prior to launch of the CA-CDSS. RESULTS: Over an 18-month period, a CA-CDSS was embedded into Epic and Allscripts at two hospital systems. The CA-CDSSs vary significantly from each other in terms of the type of triggers which were able to be used, the type of alert, the ability of the alert to link directly to child abuse-specific order sets and the order sets themselves. CONCLUSIONS: Dissemination of CA-CDSS from one EHR into the EHR in other health care systems is possible but time-consuming and needs to be adapted to the strengths and limitations of the specific EHR. Site-specific usability evaluation, buy-in of multiple stakeholder groups and significant information technology support are needed. These barriers limit scalability and widespread dissemination of CA-CDSS.
BACKGROUND: Child maltreatment is a leading cause of pediatric morbidity and mortality. We previously reported on development and implementation of a child abuse clinical decision support system (CA-CDSS) in the Cerner electronic health record (EHR). Our objective was to develop a CA-CDSS in two different EHRs. METHODS: Using the CA-CDSS in Cerner as a template, CA-CDSSs were developed for use in four hospitals in the Northwell Health system who use Allscripts and two hospitals in the University of Wisconsin health system who use Epic. Each system had a combination of triggers, alerts and child abuse-specific order sets. Usability evaluation was done prior to launch of the CA-CDSS. RESULTS: Over an 18-month period, a CA-CDSS was embedded into Epic and Allscripts at two hospital systems. The CA-CDSSs vary significantly from each other in terms of the type of triggers which were able to be used, the type of alert, the ability of the alert to link directly to child abuse-specific order sets and the order sets themselves. CONCLUSIONS: Dissemination of CA-CDSS from one EHR into the EHR in other health care systems is possible but time-consuming and needs to be adapted to the strengths and limitations of the specific EHR. Site-specific usability evaluation, buy-in of multiple stakeholder groups and significant information technology support are needed. These barriers limit scalability and widespread dissemination of CA-CDSS.
Authors: Srinivasan Suresh; Richard A Saladino; Janet Fromkin; Emily Heineman; Tom McGinn; Rudolph Richichi; Rachel P Berger Journal: J Am Med Inform Assoc Date: 2018-07-01 Impact factor: 4.497
Authors: Rachel P Berger; Richard A Saladino; Janet Fromkin; Emily Heineman; Srinivasan Suresh; Tom McGinn Journal: J Am Med Inform Assoc Date: 2018-02-01 Impact factor: 4.497