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Using CDS Hooks to increase SMART on FHIR app utilization: a cluster-randomized trial.

Keaton L Morgan1,2, Polina V Kukhareva1, Phillip B Warner1

  • 1Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.

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|May 31, 2022
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Contextually relevant Clinical Decision Support (CDS) Hooks prompts significantly increased the utilization of SMART on FHIR medical apps. This highlights the potential of CDS Hooks to improve EHR usability and healthcare delivery.

Keywords:
CDS HooksSMART on FHIRclinical decision supportelectronic health recordsstandards

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Area of Science:

  • Health Informatics
  • Clinical Decision Support Systems
  • Electronic Health Records (EHR)

Background:

  • HL7 SMART on FHIR apps offer potential benefits for healthcare delivery and EHR usability.
  • Provider awareness and utilization are crucial for realizing the benefits of these applications.
  • The HL7 CDS Hooks standard was developed to facilitate the integration and use of such tools.

Purpose of the Study:

  • To evaluate if contextually relevant CDS Hooks prompts can enhance the utilization of a SMART on FHIR medical reference application (MDCalc for EHR).
  • To assess the impact of CDS Hooks on driving the adoption of specific medical calculators within an EHR workflow.

Main Methods:

  • A 7-month, provider-randomized trial involving 70 providers in a single emergency department.
  • Intervention group received CDS Hooks prompts suggesting the use of 6 medical calculators within the SMART on FHIR app.
  • Primary outcome: percentage of provider-patient interactions involving viewing a recommended calculator; secondary outcomes: stratified app usage.

Main Results:

  • Providers receiving CDS Hooks prompts viewed a study calculator in 6.0% of interactions, compared to 2.6% in the control group (130% increase, OR=2.45, P=.02).
  • App utilization showed a significant increase for 2 out of the 6 recommended calculators.
  • The intervention demonstrated a statistically significant impact on the usage of the SMART on FHIR app.

Conclusions:

  • Contextually relevant CDS Hooks prompts effectively increased the utilization of SMART on FHIR applications.
  • This study validates the potential of CDS Hooks in guiding the appropriate use of SMART on FHIR apps.
  • Future research should explore the impact of this increased app utilization on clinical decision-making and patient outcomes.