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Dissemination of child abuse clinical decision support: Moving beyond a single electronic health record
Thomas McGinn1, David A Feldstein2, Isabel Barata3
1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States; Baylor College of Medicine, Houston, Texas, United States.
Insights
Developing child abuse clinical decision support systems (CA-CDSS) across different electronic health records (EHRs) is feasible but challenging. Adapting CA-CDSS to EHRs requires significant effort, limiting widespread adoption.
Area of Science:
- Pediatric Health
- Clinical Informatics
- Public Health
Background:
- Child maltreatment is a major cause of pediatric illness and death.
- A child abuse clinical decision support system (CA-CDSS) was previously developed for the Cerner electronic health record (EHR).
Purpose of the Study:
- To develop and implement CA-CDSS in two distinct EHR systems: Allscripts and Epic.
- To evaluate the feasibility and challenges of adapting a CA-CDSS across different healthcare IT infrastructures.
Main Methods:
- A previously developed CA-CDSS in Cerner EHR served as a template.
- CA-CDSSs were adapted for Allscripts (4 hospitals) and Epic (2 hospitals).
- Each system incorporated triggers, alerts, and child abuse-specific order sets, with pre-launch usability evaluations.
Main Results:
- Over 18 months, CA-CDSS was integrated into Epic and Allscripts systems.
- Significant variations were observed in triggers, alerts, and order set integration capabilities across EHRs.
- The effectiveness of linking alerts to order sets differed between the systems.
Conclusions:
- Disseminating CA-CDSS across different EHRs is possible but requires substantial time and EHR-specific adaptation.
- Successful implementation necessitates site-specific usability testing, stakeholder engagement, and robust IT support.
- These factors present barriers to the scalability and widespread adoption 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.
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