Clinical Decision Support: Beyond the Alert


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CHOP CBMi Informatics Symposium, April 2012
Presentation on approaches applied to a comprehensive CDS application designed to assist primary care clinicians manage the care of premature infants during their first two years of life

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Clinical Decision Support: Beyond the Alert

  1. 1. Clinical Decision Support: Beyond the Alert Dean Karavite, MSI Robert Grundmeier, MD Center for Biomedical Informatics The Children’s Hospital of Philadelphia
  2. 2. Defining Clinical Decision Support (CDS) “...the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools.” Three categories of CDS 1)“Alerting CDS such as alerts and reminders that fire to deliver information and interrupt workflow” 2)“Workflow CDS meant to ease data entry, documentation, and resource location” 3)“Cognitive CDS that provides… patient management and planning overview” CDS can be Explicit or Implicit
  3. 3. CHOP CBMi “Care Assistant”  Programming framework to enhance our commercial EMR  Developed by Dr. Robert Grundmeier and Dr. Alex Fiks  Adds five capabilities to the EMR 1. Real time EMR patient data mining 2. Integration with expert based rules engine 3. Automation of EMR functionality 4. Presentation of external content 5. New EMR info displays and user interfaces 1. Immunization Assistant 2. Asthma Assistant 3. Development Assistant 4. Short Stature Assistant 5. Otitis Media Assistant 6. Premature Infant Assistant In progress 1. Shared Decision Making 2. Surgical Site Infection 3. Genomic Sequencing
  4. 4. Premature Infant Care  NIH/NLM and AHRQ funding  Develop CDS for complex patients  Support primary care in premature infant care for first two years of life
  5. 5. Preemie Assistant: Patient Summary
  6. 6. Preemie Assistant: Growth/Nutrition
  7. 7. Preemie Assistant: Summary
  8. 8. AAP RSV-Synagis Policy Statement
  9. 9. AAP RSV-Synagis Rules
  10. 10. RSV-Synagis Workflow Nurses can spend 10-20 hours per patient managing this workflow over 6 months Some practices have over 50 patients to manage 1/8 to 1/4 Nursing FTE
  11. 11. Expanded CDS Requirements Traditional CDS  One patient at a time  At the point of care  Limited workflow support to one encounter or admission RSV-Synagis CDS  All patients at once  1-2 months in advance  6 month workflow across multiple encounters  RSV-Synagis not unique:  Management of leuprolide to delay puberty  Tracking patients for ROP  …
  12. 12. “The Synagis Binders”
  13. 13. RSV Assistant for Nurses
  14. 14. RSV-Synagis Patient List
  15. 15. Results  83% received at least one dose by 12/31 compared to 77% prior year  Socio-economics a major factor in outcomes  RSV Assistant can eliminate patient information in shadow charts  Clinic with most Synagis patients in entire network Building consensus on RSV-Synagis  Pediatric Academic Societies presentation tomorrow  CHOP specialists and others presented statements to CDC for more rigorous Palivizumab trials  GLIDES reporting downstream impact of ambiguous language to guideline authors Waning Shadows?
  16. 16. Questions/Comments? Preemie Assistant Team Primary Care Experts  Dr. Alex Fiks, Dr. Robert Grundmeier, Dr. Annique Hogan Premature Infant Experts  Dr. Judy Bernbaum, Jo Ann D'Agostino DNP, CRNP, Dr. Trude Haecker, Dr. Hallam Hurt, Dr. Scott Lorch Developers  Le Mar Davidson, Dr. Robert Grundmeier, Jeff Miller, Byron Ruth Data Analyst  Mark Ramos Study Coordination/Administration  James Massey, Valerie McGoldrick, Kelli Wynn-Moore Statisticians  Russell Localio PhD, Lihai Song GLIDES  Dr. Jeremy Michel, Dr. Richard Shiffman Additional Support Information Services  David Krill, Raja Pudivenkata, Chris Qaddoumi, Linda Tague CHOP practices contributing to system development activities  Chestnut Hill, Faculty Practice, Market Street, Paoli