Scaling and Dissemination of an Effective Clinical Decision Support Tool for Pneumonia

Lack of interoperability limits use of effective clinical decision support

Clinical decision support (CDS) tools based on the Five Rights framework—delivering the right information, to the right person, in the right format, through the right channel, at the right time in the workflow—support clinicians in making the best care decisions for patients. CDS uses patient-specific data and relies on evidence-based findings to improve health outcomes. But often these tools are not widely available or interoperable and may use proprietary technology and standards that limit use by healthcare systems with differing electronic health record (EHR) platforms.

An interoperable version of a CDS tool may be effective for pneumonia

Dr. Nathan Dean, from Intermountain Health in Utah, led the development of a CDS tool called Electronic Pneumonia (ePneumonia), used for pneumonia detection and management. The tool combines the best clinical practice and evidence to optimize provider decision making by collecting more than 50 data elements from the EHR, including symptoms, vital signs, physical exam information, laboratory results, and radiographic findings. These data help providers with diagnosis and risk stratification. ePneumonia then recommends appropriate antibiotics, guideline-consistent laboratory testing, optimum treatment location (inpatient vs. outpatient), and level of care for inpatients (e.g., acute, ICU).

ePneumonia is now embedded in the EHR at Intermountain Health and used across its 22 emergency departments (EDs). Use of the tool has improved consistency in adhering to guideline antibiotic prescribing and ultimately lowered mortality rates for patients with pneumonia.

Currently, a team of researchers, led by Drs. Dean, Curtis Langlotz of Stanford University, and Michael Ward of Vanderbilt University Medical Center, want to disseminate ePneumonia by developing an interoperable version of the tool so that it can be deployed to other health systems using different EHR platforms. Increased usage of the technology could advance its scalability, interoperability, and usability. Adapting ePneumonia using interoperable standards will employ an iterative design process informed by a formative evaluation, allowing for the refinement and validation of the application.

“I think it’s important to have real-time electronic decision support, shown to have had significant clinical outcome improvements; now we’re going to make it more generalizable using interoperable standards and adapting it to another electronic medical record.” – Dr. Nathan Dean

Dissemination of effective CDS may improve patient care

Success of the CDS tool in another organization is dependent on finetuning the tool’s algorithms to reflect the patient population. The team is testing the interoperable ePneumonia tool in Tennessee. The patient populations in the state differ dramatically from those in Utah by age, race, and comorbidities, allowing the researchers to test and refine the model to ensure its accuracy and performance. Equally important to the success of the tool is understanding the voice of the patient and how they want providers to discuss the severity of illness and care decisions with them. To address this, the researchers will conduct community engagement sessions with patients who have recovered from pneumonia to inform the refinement of the ePneumonia interface for providers.

The updated ePneumonia tool will be implemented in two EDs at Vanderbilt University Medical Center in a pilot study to evaluate its feasibility and acceptability. This research has the potential to improve outcomes for patients with pneumonia by improving decision making at the point of care, increasing the use of guidelines-based treatments, and overcoming the barriers to sharing interoperable CDS tools.