Implementation of a Novel Multi-Platform Evidence-Based Clinical Decision Support System (New York)

Project Details - Ongoing

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Clinical decision support (CDS) tools provide physicians and other healthcare providers with assistance in clinical decision-making tasks. Historically, these tools have been designed and built within organizations for specific electronic health records (EHRs) and clinical environments. This method of development has meant that these tools can’t be used across organizations and clinical settings. In addition, when guidelines change, each individual organization must update their individual tools--a process many fail to do in a timely fashion, resulting in potential patient safety issues.

For more than a decade, the Northwell Health Center for Health Innovations and Outcomes Research (CHIOR) has been developing, testing, validating, and evaluating CDS tools and systems. CHIOR’s primary focus has been on clinical prediction rules (CPRs), a form of CDS that uses data to calculate patient-specific probabilities. Recently, the focus has been on increasing the speed at which evidence is translated into clinical practice utilizing CDS. One mechanism to accomplish this would be to shift to a model that is vendor-agnostic using a service-oriented architecture (SOA) software running outside of an EHR. This model would allow tools to be available to any EHR within any organization and clinical setting, and to allow for broader updating when guidelines change. Such an approach would markedly reduce the cost of developing and maintaining CDS, and potentially increase the uptake of evidence-based research findings into clinical practice. This current research will develop, test, and evaluate an SOA platform-based CDS system. Two evidence-based derived and validated CPRs - the IMPROVE Risk Model for Venous Thromboembolism and the Wells’ criteria for pulmonary embolism – will be made available via this platform utilizing Fast Healthcare Interoperability Resources (FHIR) standards where possible. The research will take place in two healthcare settings: inpatient and the emergency department, at two clinical sites, using two different commercial EHRs.

The specific aims of the research are as follows:

  • Blend CDS into the flow of clinical care by embedding two widely validated CPRs in two commercial EHRs using a CDS system built on a SOA. 
  • Leverage the results of iterative cycles of “think aloud,” “near live,” and live usability testing to map how the SOA-based CDS system should be integrated into the two selected clinical sites. 
  • Evaluate the effectiveness of the SOA-based CDS system in each healthcare environment by measuring adoption, acceptance, and clinical outcomes. 

Usability testing will be conducted using “think aloud” methods, full-scale patient simulators, and live testing at clinical sites. Additionally, researchers will evaluate provider adoption rates and the impact of CDS on clinical outcomes pre- versus post-intervention. By implementing two previously studied and evaluated CPRs this study will assess the impact of a vendor-neutral platform-independent CDS on provider behavior in inpatient and emergency care settings. The researchers anticipate that the system will be successfully implemented and usable, and the project expanded across EHRs from a full spectrum of vendors.

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