Clinical Decision Support: Beyond the Alert

Clinical Decision Support: Beyond the Alert

Dean Karavite, MSIRobert Grundmeier, MD

Center for Biomedical Informatics The Children’s Hospital of Philadelphia

Defining Clinical Decision Support (CDS)

“...the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools.”

Three categories of CDS1)“Alerting CDS such as alerts and reminders that fire to deliver information and interrupt workflow”2)“Workflow CDS meant to ease data entry, documentation, and resource location”3)“Cognitive CDS that provides… patient management and planning overview”

CDS can be Explicit or Implicit

CHOP CBMi “Care Assistant”

Programming framework to enhance our commercial EMR Developed by Dr. Robert Grundmeier and Dr. Alex Fiks

Adds five capabilities to the EMR1. Real time EMR patient data mining2. Integration with expert based rules engine3. Automation of EMR functionality4. Presentation of external content5. New EMR info displays and user interfaces

1. Immunization Assistant2. Asthma Assistant3. Development Assistant4. Short Stature Assistant5. Otitis Media Assistant6. Premature Infant Assistant

In progress1. Shared Decision Making2. Surgical Site Infection3. Genomic Sequencing

Premature Infant Care

NIH/NLM and AHRQ funding Develop CDS for complex

patients Support primary care in

premature infant care for first two years of life

Preemie Assistant: Patient Summary

Preemie Assistant: Growth/Nutrition

Preemie Assistant: Summary

AAP RSV-Synagis Policy Statement

AAP RSV-Synagis Rules

RSV-Synagis Workflow

Nurses can spend 10-20 hours per patient managing this workflow over 6 months

Some practices have over 50 patients to manage1/8 to 1/4 Nursing FTE

Expanded CDS Requirements

Traditional CDS One patient at a time At the point of care Limited workflow support

to one encounter or admission

RSV-Synagis CDS All patients at once 1-2 months in advance 6 month workflow across multiple encounters

RSV-Synagis not unique: Management of leuprolide to delay puberty Tracking patients for ROP …

“The Synagis Binders”

RSV Assistant for Nurses

RSV-Synagis Patient List

Results

83% received at least one dose by 12/31 compared to 77% prior year Socio-economics a major factor in outcomes

RSV Assistant can eliminate patient information in shadow charts Clinic with most Synagis patients in entire network

Building consensus on RSV-Synagis Pediatric Academic Societies presentation

tomorrow CHOP specialists and others presented

statements to CDC for more rigorous Palivizumab trials

GLIDES reporting downstream impact of ambiguous language to guideline authors

Waning Shadows?

Questions/Comments?

Preemie Assistant TeamPrimary Care Experts

Dr. Alex Fiks, Dr. Robert Grundmeier, Dr. Annique HoganPremature Infant Experts

Dr. Judy Bernbaum, Jo Ann D'Agostino DNP, CRNP, Dr. Trude Haecker, Dr. Hallam Hurt, Dr. Scott Lorch Developers

Le Mar Davidson, Dr. Robert Grundmeier, Jeff Miller, Byron RuthData Analyst

Mark RamosStudy Coordination/Administration

James Massey, Valerie McGoldrick, Kelli Wynn-MooreStatisticians

Russell Localio PhD, Lihai Song

GLIDES Dr. Jeremy Michel, Dr. Richard Shiffman

Additional SupportInformation Services

David Krill, Raja Pudivenkata, Chris Qaddoumi, Linda TagueCHOP practices contributing to system development activities

Chestnut Hill, Faculty Practice, Market Street, Paoli