使用基于快速医疗互操作性资源（FHIR）的可扩展医疗记录技术（SMART）减少拔牙阿片类药物处方的临床决策支持：实施报告

Clinical Decision Support to Reduce Opioid Prescriptions for Dental Extractions using SMART on FHIR: Implementation Report.

作者信息

Rindal D Brad, Pasumarthi Dhavan Prasad, Thirumalai Vijayakumar, Truitt Anjali R, Asche Stephen E, Worley Donald C, Kane Sheryl M, Gryczynski Jan, Mitchell Shannon G

机构信息

HealthPartners Institute, Minneapolis, MN, United States.

Memorial Hermann Health System, Houston, TX, United States.

出版信息

JMIR Med Inform. 2023 Nov 7;11:e45636. doi: 10.2196/45636.

DOI:10.2196/45636

PMID:37934572

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10664010/

Abstract

BACKGROUND

Clinical decision support (CDS) has the potential to improve clinical decision-making consistent with evidence-based care. CDS can be designed to save health care providers time and help them provide safe and personalized analgesic prescribing.

OBJECTIVE

The aim of this report is to describe the development of a CDS system designed to provide dentists with personalized pain management recommendations to reduce opioid prescribing following extractions. The use of CDS is also examined.

METHODS

This study was conducted in HealthPartners, which uses an electronic health record (EHR) system that integrates both medical and dental information upon which the CDS application was developed based on SMART (Substitutable Medical Applications and Reusable Technologies) on FHIR (Fast Healthcare Interoperability Resources). The various tools used to bring relevant medical conditions, medications, patient history, and other relevant data into the CDS interface are described. The CDS application runs a drug interaction algorithm developed by our organization and provides patient-specific recommendations. The CDS included access to the state Prescription Monitoring Program database.

IMPLEMENTATION (RESULTS): The pain management CDS was implemented as part of a study examining opioid prescribing among patients undergoing dental extraction procedures from February 17, 2020, to May 14, 2021. Provider-level use of CDS at extraction encounters ranged from 0% to 87.4% with 12.1% of providers opening the CDS for no encounters, 39.4% opening the CDS for 1%-20% of encounters, 36.4% opening it for 21%-50% of encounters, and 12.1% opening it for 51%-87% of encounters.

CONCLUSIONS

The pain management CDS is an EHR-embedded, provider-facing tool to help dentists make personalized pain management recommendations following dental extractions. The SMART on FHIR-based pain management CDS adapted well to the point-of-care dental setting and led to the design of a scalable CDS tool that is EHR vendor agnostic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03584789; https://clinicaltrials.gov/study/NCT03584789.

摘要

背景

临床决策支持（CDS）有潜力改善与循证医疗相一致的临床决策。CDS的设计目的可以是节省医疗服务提供者的时间，并帮助他们提供安全且个性化的镇痛处方。

目的

本报告旨在描述一个CDS系统的开发，该系统旨在为牙医提供个性化的疼痛管理建议，以减少拔牙后的阿片类药物处方。同时也对CDS的使用情况进行了研究。

方法

本研究在HealthPartners进行，该机构使用电子健康记录（EHR）系统，该系统整合了医疗和牙科信息，基于FHIR（快速医疗互操作性资源）上的SMART（可替代医疗应用和可重用技术）开发了CDS应用程序。描述了用于将相关医疗状况、药物、患者病史及其他相关数据引入CDS界面的各种工具。CDS应用程序运行由我们机构开发的药物相互作用算法，并提供针对患者的建议。CDS包括对州处方监测计划数据库的访问权限。

实施（结果）：疼痛管理CDS作为一项研究的一部分得以实施，该研究考察了2020年2月17日至2021年5月14日接受拔牙手术患者的阿片类药物处方情况。在拔牙诊疗过程中，提供者对CDS的使用比例从0%到87.4%不等，其中12.1%的提供者在任何诊疗中都未打开CDS，39.4%的提供者在1%-20%的诊疗中打开CDS，36.4%的提供者在21%-50%的诊疗中打开CDS，12.1%的提供者在51%-87%的诊疗中打开CDS。