TY - JOUR
T1 - Clinical decision support for a multicenter trial of pediatric head trauma
T2 - Development, implementation, and lessons learned
AU - Tham, Eric
AU - Swietlik, Marguerite
AU - Deakyne, Sara
AU - Hoffman, Jeffrey M.
AU - Grundmeier, Robert W.
AU - Paterno, Marilyn D.
AU - Rocha, Beatriz H.
AU - Schaeffer, Molly H.
AU - Pabbathi, Deepika
AU - Alessandrini, Evaline
AU - Ballard, Dustin
AU - Goldberg, Howard S.
AU - Kuppermann, Nathan
AU - Dayan, Peter S.
PY - 2016/6/15
Y1 - 2016/6/15
N2 - Introduction: For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinicallyimportant traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial. Methods: Thirteen EDs participated in this trial. The 10 sites receiving the CDS intervention used the Epic® EHR. All sites implementing EHR-based CDS built the rules by using the vendor’s CDS engine. Based on a sociotechnical analysis, we designed the CDS so that recommendations could be displayed immediately after any provider entered prediction rule data. One central site developed and tested the intervention package to be exported to other sites. The intervention package included a clinical trial alert, an electronic data collection form, the CDS rules and the format for recommendations. Results: The original PECARN head trauma prediction rules were derived from physician documentation while this pragmatic trial led each site to customize their workflows and allow multiple different providers to complete the head trauma assessments. These differences in workflows led to varying completion rates across sites as well as differences in the types of providers completing the electronic data form. Site variation in internal change management processes made it challenging to maintain the same rigor across all sites. This led to downstream effects when data reports were developed. Conclusions: The process of a centralized build and export of a CDS system in one commercial EHR system successfully supported a multicenter clinical trial.
AB - Introduction: For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinicallyimportant traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial. Methods: Thirteen EDs participated in this trial. The 10 sites receiving the CDS intervention used the Epic® EHR. All sites implementing EHR-based CDS built the rules by using the vendor’s CDS engine. Based on a sociotechnical analysis, we designed the CDS so that recommendations could be displayed immediately after any provider entered prediction rule data. One central site developed and tested the intervention package to be exported to other sites. The intervention package included a clinical trial alert, an electronic data collection form, the CDS rules and the format for recommendations. Results: The original PECARN head trauma prediction rules were derived from physician documentation while this pragmatic trial led each site to customize their workflows and allow multiple different providers to complete the head trauma assessments. These differences in workflows led to varying completion rates across sites as well as differences in the types of providers completing the electronic data form. Site variation in internal change management processes made it challenging to maintain the same rigor across all sites. This led to downstream effects when data reports were developed. Conclusions: The process of a centralized build and export of a CDS system in one commercial EHR system successfully supported a multicenter clinical trial.
KW - Blunt head trauma
KW - Children
KW - Clinical decision support
KW - Clinical trial
KW - Implementation
KW - Traumatic brain injury
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U2 - 10.4338/ACI-2015-10-CR-0144
DO - 10.4338/ACI-2015-10-CR-0144
M3 - Article
C2 - 27437059
AN - SCOPUS:84981343554
VL - 7
SP - 534
EP - 542
JO - Applied Clinical Informatics
JF - Applied Clinical Informatics
SN - 1869-0327
IS - 2
ER -