Introduction: Clinical decision support (CDS) integrating patient and family generated data with screening tools and the electronic medical record (EMR) can aid in safe, timely, effective, efficient and patient-centered care. However, pediatric specific CDS tools are not always activated in EMRs. We present a successful integration of a validated web-based pediatric clinical decision support tool with a vendor EMR product. Method: Child Health Improvement through Computer Automation (CHICA) is a pediatric clinical decision support system developed and implemented in other EMRs as previously reported; however, it had not been integrated in the model vendor workflow. Working with the vendor EMR team and the CHICA research team, an interface and workflow we developed to provide an effective and efficient way to gather patient responses and the actions taken by the clinical team, and then integrate those into the recommended vendor workflow. Results: The workflow was designed and implemented. When a patient is registered, the vendor EMR sends an HL7 ADT message to CHICA. The patient is given a tablet which connects to CHICA and provides specific questions which patients and families complete. The tablet data is sent back to CHICA. On receipt of this message, CHICA requests additional clinical data from the EMR including age, gender, specific diagnoses, and set of clinical data including blood pressure and weight. CHICA then applies a set of Arden Syntax MLMs or rules to the data in order to generate patient and visit specific document forms within CHICA. The clinical team – physicians, nurse practitioners and others – access CHICA directly for that patient via a button in the vendor EMR toolbar. The clinical team then completes a ‘worksheet’ within CHICA which reflects the counselling and education given in response to patient needs. After the worksheet is completed, CHICA returns a summary to the vendor EMR using an HL7 message. The clinician uses a global autotext (a “dotphrase”) to retrieve the relevant content from the CHICA summary and include it in readable form in the note. This workflow was implemented and supported by both the CHICA research team and the clinical IS team of the vendor EMR. Conclusion: Integration of web-based pediatric clinical decision support can help enable patient-specific action within the EMR; however, an effective adoption requires the clinical team experience to be aligned with other pieces of their workflow. This integration leveraged the known integration of the HL7 messages to and from the vendor EMR, as well as an updated documentation workflow which allows for easier retrieval of the CHICA summary. Evaluation of the clinical team, patient and care-giver’s satisfaction with this tool is part of an ongoing study.
Integration of a pediatric web-based clinical decision support tool into a recommended vendor EMR workflow
- Views Icon Views
- Share Icon Share
- Search Site
Emily Webber, Stephen M. Downs, Phillip Cadle, Steven McKee, James Nelson, Tamara S. Hannon; Integration of a pediatric web-based clinical decision support tool into a recommended vendor EMR workflow. Pediatrics July 2020; 146 (1_MeetingAbstract): 19–20. 10.1542/peds.146.1MA1.19
Download citation file: