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儿童虐待临床决策支持的传播：超越单一电子健康记录。

Dissemination of child abuse clinical decision support: Moving beyond a single electronic health record.

机构信息

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States; Baylor College of Medicine, Houston, Texas, United States.

University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.

出版信息

Int J Med Inform. 2021 Mar;147:104349. doi: 10.1016/j.ijmedinf.2020.104349. Epub 2020 Dec 10.

DOI:10.1016/j.ijmedinf.2020.104349
PMID:33360791
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8351590/
Abstract

BACKGROUND

Child maltreatment is a leading cause of pediatric morbidity and mortality. We previously reported on development and implementation of a child abuse clinical decision support system (CA-CDSS) in the Cerner electronic health record (EHR). Our objective was to develop a CA-CDSS in two different EHRs.

METHODS

Using the CA-CDSS in Cerner as a template, CA-CDSSs were developed for use in four hospitals in the Northwell Health system who use Allscripts and two hospitals in the University of Wisconsin health system who use Epic. Each system had a combination of triggers, alerts and child abuse-specific order sets. Usability evaluation was done prior to launch of the CA-CDSS.

RESULTS

Over an 18-month period, a CA-CDSS was embedded into Epic and Allscripts at two hospital systems. The CA-CDSSs vary significantly from each other in terms of the type of triggers which were able to be used, the type of alert, the ability of the alert to link directly to child abuse-specific order sets and the order sets themselves.

CONCLUSIONS

Dissemination of CA-CDSS from one EHR into the EHR in other health care systems is possible but time-consuming and needs to be adapted to the strengths and limitations of the specific EHR. Site-specific usability evaluation, buy-in of multiple stakeholder groups and significant information technology support are needed. These barriers limit scalability and widespread dissemination of CA-CDSS.

摘要

背景

儿童虐待是导致儿科发病率和死亡率的主要原因。我们之前曾报道过在 Cerner 电子病历 (EHR) 中开发和实施儿童虐待临床决策支持系统 (CA-CDSS) 的情况。我们的目标是在两个不同的 EHR 中开发 CA-CDSS。

方法

使用 Cerner 中的 CA-CDSS 作为模板，为使用 Allscripts 的 Northwell Health 系统的四家医院和使用 Epic 的威斯康星大学卫生系统的两家医院开发了 CA-CDSS。每个系统都有一组触发因素、警报和特定于儿童虐待的医嘱集。在推出 CA-CDSS 之前进行了可用性评估。

结果

在 18 个月的时间里，在两个医院系统中，将 CA-CDSS 嵌入到 Epic 和 Allscripts 中。CA-CDSS 在能够使用的触发因素类型、警报类型、警报直接链接到特定于儿童虐待的医嘱集的能力以及医嘱集本身方面存在显著差异。

结论

将 CA-CDSS 从一个 EHR 传播到其他医疗保健系统的 EHR 是可行的，但耗时且需要适应特定 EHR 的优势和局限性。需要进行特定于站点的可用性评估、多个利益相关者群体的认可以及大量信息技术支持。这些障碍限制了 CA-CDSS 的可扩展性和广泛传播。

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