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Appl Clin Inform 2025; 16(02): 283-294
DOI: 10.1055/a-2480-4628
Research Article

Multisite Implementation of a Sexual Health Survey and Clinical Decision Support to Promote Adolescent Sexually Transmitted Infection Screening

Sarah K. Schmidt
1   Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Judith W. Dexheimer
2   Divisions of Emergency Medicine and Biomedical Informatics, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Joseph J. Zorc
3   Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Chella A. Palmer
4   University of Utah School of Medicine, Salt Lake City, Utah, United States
,
T Charles Casper
4   University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Kristin S. Stukus
5   Division of Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio, United States
,
Michelle L. Pickett
6   Division of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
,
Cynthia J. Mollen
3   Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Cara L. Elsholz
4   University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Andrea T. Cruz
7   Divisions of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
,
Erin M. Augustine
8   Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Monika K. Goyal   *
9   Division of Emergency Medicine, Department of Pediatrics, Children's National Hospital, George Washington University, Washington, District of Columbia, United States
,
Jennifer L. Reed   *
10   Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
› Author Affiliations Funding This study was funded by NIH/NICHD grant R01HD094213 (Goyal/Reed). PECARN is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), the Maternal and Child Health Bureau (MCHB), under the Emergency Medical Services for Children (EMSC) program through the following cooperative agreements: EMSC Data Center (EDC)–University of Utah (UJ5MC30824), GLACiER–Nationwide Children's Hospital (U03MC28844), HOMERUN–Cincinnati Children's Hospital Medical Center (U03MC22684), PEMNEWS–Columbia University Medical Center (U03MC00007), PRIME–University of California at Davis Medical Center (U03MC00001), CHaMP node–State University of New York at Buffalo (U03MC33154), STELAR–Seattle Children's Hospital (U03MC33156), and SPARC node–Emory University School of Medicine (U03MC49671). This information or content and conclusions are those of the authors and should not be construed as the official position, or policy of, nor should be inferred as any endorsement by HRSA, HHS, or the U.S. Government.
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Abstract

Background Adolescents are at high risk for sexually transmitted infections (STIs) and frequently present to emergency departments (EDs) for care. Screening for STIs using confidential patient-reported outcomes represents an ideal use of electronic screening methodology.

Objectives The objectives of this study were to implement a patient-facing, confidential electronic survey to assess adolescent risk for STIs and consent for testing with integrated provider-facing electronic clinical decision support (CDS) across six geographically dispersed pediatric EDs and evaluate implementation based on survey and CDS usage metrics.

Methods A pilot site provided code for the electronic survey, data query, and CDS templates to six EDs. Institutions identified necessary information technology (IT) personnel, completed the local build, and made modifications to suit individual site workflow variations with all sites successfully deploying the electronic survey with electronic health record (EHR)-embedded CDS.

Results Out of 79,780 eligible adolescents, 6,165 adolescents completed the confidential health survey between April 12, 2021 and September 25, 2022. The CDS was triggered indicating the patient was at risk or consented to STI testing across all six sites 2,058 times. The average percentage of time the CDS was acknowledged by a provider was 81.6% (range 45.7–97.6%). The median number of providers who acknowledged each instance of the CDS was 2.0. STI testing was ordered from the CDS on average 47.3% of the time. CDS acknowledged selection of “other” and “[testing] already ordered” was the most frequent indication STI testing was not ordered from the CDS.

Conclusion Successful deployment of patient-facing screeners with integrated electronic CDS across multiple healthcare institutions is feasible. A combination of different types of IT and informatics expertise with local knowledge of clinical workflows is essential to success.

Keywords

clinical decision support - electronic health record - patient-reported outcomes - pediatrics - emergency medicine

Protection of Human and Animal Subjects

This study was approved by each institution's Institutional Review Board (IRB) through a single IRB mechanism with a waiver of parental consent for participation. All study subjects provided informed consent before participation.


* Denotes co-senior authorship.


Supplementary Material



Publication History

Received: 20 April 2024

Accepted: 20 November 2024

Accepted Manuscript online:
21 November 2024

Article published online:
02 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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