TY  - JOUR
PY  - 2016//
TI  - Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma
JO  - International journal of medical informatics
A1  - Goldberg, Howard S.
A1  - Paterno, Marilyn D.
A1  - Grundmeier, Robert W.
A1  - Rocha, Beatriz H.
A1  - Hoffman, Jeffrey M.
A1  - Tham, Eric
A1  - Swietlik, Marguerite
A1  - Schaeffer, Molly H.
A1  - Pabbathi, Deepika
A1  - Deakyne, Sara J.
A1  - Kuppermann, Nathan
A1  - Dayan, Peter S.
SP  - 101
EP  - 110
VL  - 87
IS  - 
N2  - OBJECTIVE: To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma. <br><br>MATERIALS AND METHODS: We integrated the Epic(®) electronic health record (EHR) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments. Patterns of CDS review included either a delayed, near-real-time review, where the physician viewed CDS recommendations generated by the nursing assessment, or a real-time review, where the physician viewed recommendations generated by their own documentation. A backstopping, vendor-based CDS triggered with zero delay when no recommendation was available in the EHR from the web-service. We assessed the execution characteristics of the integrated system and the source of the generated recommendations viewed by physicians. <br><br>RESULTS: The ECRS mean execution time was 0.74 ±0.72s. Overall execution time was substantially different at the two sites, with mean total transaction times of 19.67 and 3.99s. Of 1930 analyzed transactions from the two sites, 60% (310/521) of all physician documentation-initiated recommendations and 99% (1390/1409) of all nurse documentation-initiated recommendations originated from the remote web service. <br><br>DISCUSSION: The remote CDS system was the source of recommendations in more than half of the real-time cases and virtually all the near-real-time cases. Comparisons are limited by allowable variation in user workflow and resolution of the EHR clock. <br><br>CONCLUSION: With maturation and adoption of standards for CDS services, remote CDS shows promise to decrease time-to-trial for multicenter evaluations of candidate decision support interventions.<p />  <p>Language: en</p>
LA  - en
SN  - 1386-5056
UR  - http://dx.doi.org/10.1016/j.ijmedinf.2015.12.002
ID  - ref1
ER  -