EP02.03 - Randomized Controlled Monitoring of EMR Clinical Decision Support
e-Health ePoster Library. Ballermann M. Jun 7, 2016; 131570; EP02.03
Mark Ballermann
Mark Ballermann
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Purpose/Objectives: Measurement of intended and unintended uses of clinical information systems (CIS) is key to assessing the impact of clinical decision support (CDS) on information behaviors, clinical practices, and health outcomes. Although medication alerts, for example, are promoted for improved patient safety at reduced cost, high false positive rates can contribute to alert fatigue and inattention to all alerts and reminders. To date, validated protocols for assessing clinician responses to CDS interventions have been difficult to find and apply. The objective is to describe the methods, barriers, ethical considerations and desired outputs of a randomized controlled protocol for monitoring point of care CDS interventions in a commercial off-the-shelf CIS. Methodology/Approach: CDS interventions are triggered when unique combinations of patient, provider, setting and investigation data arise. The triggering event can be linked to one or more actions, such as the display of interruptive or non-interruptive reminders. Control groups are configured such that triggers are recorded but 'silent' where intervention groups experience both trigger and action. Clinician groups can be randomized to alternating time blocks of control and intervention CDS modes while CDS-relevant clinician behaviors (e.g. guideline compliance) are recorded for all groups at all times. Finding/Results: Based on high-fidelity usage data for CIS workflows, orders and documentation, we correlate changes in CIS use and clinical behaviors with CDS action exposures. Linked practice and health outcomes will be monitored to identify unintended consequences resulting from either the CDS intervention or the CDS evaluation methodology. Conclusion/Implication/Recommendations: The randomized delivery of silent and active CDS modes while monitoring clinical choices and outcomes can both improve CDS-medicated quality improvement and engage users in iterative enhancement of CIS-anchored CDS. 140 Character Summary: Methods and barriers to a randomized controlled protocol for clinical decision support in an enterprise wide electronic medical record.
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