Saleh Sameh N, Kim Eric, Thayer Jeritt G, Nabi-Burza Emara, Karavite Dean J, Winickoff Jonathan P, Fiks Alexander G, Jenssen Brian P, Riley Nicholas, Grundmeier Robert W
Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Appl Clin Inform. 2025 May;16(3):516-525. doi: 10.1055/a-2535-5823. Epub 2025 Feb 11.
Experiences sharing complex workflow-integrated clinical decision support (CDS) across health systems are sparse and not well reported. This case study presents the sharing of a hybrid electronic health record (EHR)-native and SMART-compatible CDS tool for automating provision of smoking cessation treatment for caregivers during pediatric visits.We conducted a comprehensive needs assessment using sociotechnical frameworks to identify workflow gaps and technical requirements. A multidisciplinary team of clinical informaticians, software developers, and EHR analysts guided the technology transfer. Iterative testing and feedback informed modifications. The evaluation tracked questionnaire uptake, tobacco use identification rates, and treatment acceptance metrics.The needs assessment revealed critical artifacts such as data architecture, source code repositories, and regulatory requirements, which informed adaptations for the recipient health system. In the preimplementation phase, JXPORT was identified for transferring EHR-native components and the EHR's Active Guidelines Framework was needed to extend the Fast Healthcare Interoperability Resources standard with ordering, posting flowsheet values, and launching activities in the embedded web application. The implementation process resulted in key modifications including same-day nicotine replacement therapy delivery through internal pharmacy services and optimized questionnaire design to improve usability. At the source system, 5.8% ( = 3,391) of caregivers reported active tobacco use with 46.9% ( = 1,590) accepting cessation resources. At the recipient system, 24.3% ( = 167) of caregivers listed tobacco use and 28.1% ( = 47) accepted treatment.The cross-system sharing of eCEASE serves as a nascent model for disseminating complex CDS tools and highlighted opportunities for improvement. Future work should focus on creating validated dissemination frameworks and improving use of standards for EHR integration.
跨医疗系统共享复杂的工作流程集成临床决策支持（CDS）的经验很少，且报道不足。本案例研究展示了一种混合的电子健康记录（EHR）原生且与SMART兼容的CDS工具的共享，该工具用于在儿科就诊期间自动为照顾者提供戒烟治疗。我们使用社会技术框架进行了全面的需求评估，以确定工作流程差距和技术要求。由临床信息学家、软件开发人员和EHR分析师组成的多学科团队指导了技术转移。迭代测试和反馈为修改提供了依据。评估跟踪了问卷的使用情况、烟草使用识别率和治疗接受指标。需求评估揭示了关键要素，如数据架构、源代码存储库和监管要求，这些为接收方医疗系统的调整提供了参考。在实施前阶段，确定了JXPORT用于转移EHR原生组件，并且需要EHR的主动指南框架来通过订单、发布流程图值以及在嵌入式Web应用程序中启动活动来扩展快速医疗保健互操作性资源标准。实施过程导致了关键修改，包括通过内部药房服务提供当日尼古丁替代疗法以及优化问卷设计以提高可用性。在源系统中，5.8%（n = 3391）的照顾者报告有主动吸烟行为，其中46.9%（n = 1590）接受了戒烟资源。在接收系统中，24.3%（n = 167）的照顾者列出有烟草使用情况，28.1%（n = 47）接受了治疗。eCEASE的跨系统共享作为传播复杂CDS工具的一种新兴模式，并突出了改进的机会。未来的工作应侧重于创建经过验证的传播框架并改善EHR集成标准的使用。
