Feldstein David A, Barata Isabel, McGinn Thomas, Heineman Emily, Ross Joshua, Kaplan Dana, Bullaro Francesca, Khan Sundas, Kuehnel Nicholas, Berger Rachel P
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
JAMIA Open. 2023 Apr 13;6(2):ooad022. doi: 10.1093/jamiaopen/ooad022. eCollection 2023 Jul.
The use of electronic health record (EHR)-embedded child abuse clinical decision support (CA-CDS) may help decrease morbidity from child maltreatment. We previously reported on the development of CA-CDS in Epic and Allscripts. The objective of this study was to implement CA-CDS into Epic and Allscripts and determine its effects on identification, evaluation, and reporting of suspected child maltreatment.
After a preimplementation period, CA-CDS was implemented at University of Wisconsin (Epic) and Northwell Health (Allscripts). Providers were surveyed before the go-live and 4 months later. Outcomes included the proportion of children who triggered the CA-CDS system, had a positive Child Abuse Screen (CAS) and/or were reported to Child Protective Services (CPS).
At University of Wisconsin (UW), 3.5% of children in the implementation period triggered the system. The CAS was positive in 1.8% of children. The proportion of children reported to CPS increased from 0.6% to 0.9%. There was rapid uptake of the abuse order set.At Northwell Health (NW), 1.9% of children in the implementation period triggered the system. The CAS was positive in 1% of children. The child abuse order set was rarely used. Preimplementation, providers at both sites were similar in desire to have CA-CDS system and perception of CDS in general. After implementation, UW providers had a positive perception of the CA-CDS system, while NW providers had a negative perception.
CA-CDS was able to be implemented in 2 different EHRs with differing effects on clinical care and provider feedback. At UW, the site with higher uptake of the CA-CDS system, the proportion of children who triggered the system and the rate of positive CAS was similar to previous studies and there was an increase in the proportion of cases of suspected abuse identified as measured by reports to CPS. Our data demonstrate how local environment, end-users' opinions, and limitations in the EHR platform can impact the success of implementation.
When disseminating CA-CDS into different hospital systems and different EHRs, it is critical to recognize how limitations in the functionality of the EHR can impact the success of implementation. The importance of collecting, interpreting, and responding to provider feedback is of critical importance particularly with CDS related to child maltreatment.
使用嵌入电子健康记录（EHR）的虐待儿童临床决策支持系统（CA-CDS）可能有助于降低虐待儿童导致的发病率。我们之前报道过在Epic和Allscripts系统中开发CA-CDS的情况。本研究的目的是在Epic和Allscripts系统中实施CA-CDS，并确定其对疑似虐待儿童的识别、评估和报告的影响。
在实施前阶段之后，CA-CDS在威斯康星大学（Epic系统）和诺斯韦尔健康中心（Allscripts系统）实施。在上线前和4个月后对医疗服务提供者进行了调查。结果包括触发CA-CDS系统的儿童比例、儿童虐待筛查（CAS）呈阳性和/或被报告给儿童保护服务机构（CPS）的儿童比例。
在威斯康星大学（UW），实施期间3.5%的儿童触发了该系统。1.8%的儿童CAS呈阳性。报告给CPS的儿童比例从0.6%增加到了0.9%。虐待医嘱集的使用迅速增加。在诺斯韦尔健康中心（NW），实施期间1.9%的儿童触发了该系统。1%的儿童CAS呈阳性。儿童虐待医嘱集很少被使用。在实施前，两个地点的医疗服务提供者在拥有CA-CDS系统的意愿和对CDS的总体认知方面相似。实施后，UW的医疗服务提供者对CA-CDS系统有积极的认知，而NW的医疗服务提供者则有消极的认知。
CA-CDS能够在两种不同的EHR中实施，对临床护理和医疗服务提供者的反馈有不同的影响。在UW，CA-CDS系统采用率较高的地点，触发该系统的儿童比例和CAS阳性率与之前的研究相似，并且从向CPS报告的情况衡量，疑似虐待病例的比例有所增加。我们的数据表明了当地环境、终端用户的意见以及EHR平台的局限性如何影响实施的成功。
在将CA-CDS推广到不同的医院系统和不同的EHR时，认识到EHR功能的局限性如何影响实施的成功至关重要。收集、解释和回应医疗服务提供者的反馈非常重要，特别是对于与虐待儿童相关的CDS。
