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Clinical Decision Support for Hyperbilirubinemia Risk Assessment in the Electronic Health Record
John D Petersen1, Margaret Lozovatsky2, Daniela Markovic2
1Olive View-UCLA Medical Center (JD Petersen), Sylmar, Calif.
Insights
Implementing an electronic health record tool significantly improved the accuracy of neonatal hyperbilirubinemia risk assessment, reducing documentation errors for jaundice risk levels in newborns.
Area of Science:
- Neonatology
- Medical Informatics
- Public Health
Background:
- Physiologic neonatal hyperbilirubinemia (jaundice) affects most newborns, but high bilirubin levels pose a risk of neurological damage.
- Accurate risk assessment using bilirubin levels, risk factors, and nomograms is crucial for managing neonatal jaundice.
- Manual assessment is time-consuming and prone to errors, leading to the development of tools like BiliTool.
Purpose of the Study:
- To integrate neonatal hyperbilirubinemia risk assessment into the electronic health record (EHR) for streamlined management.
- To develop and evaluate a tool named "BiliReport" for automating data transmission and improving documentation accuracy.
Main Methods:
- Created "BiliReport" to display patient data and automatically send deidentified information to the BiliTool website.
- Evaluated BiliReport's usage, provider satisfaction, and accuracy of documentation post-implementation.
Main Results:
- High provider utilization and satisfaction with the BiliReport workflow were observed.
- A significant reduction in erroneous bilirubin risk level documentation from 4% to 0.4% (P < 0.001) was achieved.
- No significant difference was found in the accuracy of documenting bilirubin lab values (P = 0.07).
Conclusions:
- Integrating neonatal hyperbilirubinemia risk assessment into EHR systems can minimize errors.
- Improved provider documentation and adherence to clinical guidelines are potential benefits of EHR integration.
Background:
Physiologic neonatal hyperbilirubinemia (jaundice) is common and affects most newborn infants. However, there is a risk for permanent neurological damage if the bilirubin levels rise above a certain threshold. The management of neonatal jaundice includes the assessment of bilirubin laboratory values, consideration of patient-specific risk factors, and plotting on a bilirubin nomogram reference to determine risk and guide therapy. When performed manually, the process can be time consuming and error-prone. Therefore, web-based calculators such as BiliTool have been developed to assist in risk assessment.
Methods:
To streamline the risk assessment calculation process further within our electronic health record (EHR), we created a "BiliReport" to display patient bilirubin-related data and automate transmission of deidentified patient data to the BiliTool website (https://bilitool.org). After implementation, we evaluated usage data, provider satisfaction, and accuracy of documentation.
Results:
We demonstrated high provider use of the BiliReport and satisfaction with the workflow. We found a significant improvement in the accuracy of bilirubin risk level documentation, with a reduction in erroneous risk stratification from 4% (15/232) to 0.4% (1/243), P < 0.001. We did not find significant a difference in erroneous documentation of the bilirubin lab value (P = 0.07).
Conclusions:
Integrating the neonatal hyperbilirubinemia risk assessment process into the EHR may reduce errors and improve provider documentation and adherence to recommended guidelines.
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