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Appl Clin Inform 2025; 16(03): 589-594
DOI: 10.1055/a-2555-2441
Special Issue on CDS Failures

A Case Study: Optimizing CDS for Pediatric Oncology Trials by Transitioning from Interruptive to Passive Alerts

Renee Potashner
1   Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
,
Natalie Meyer
1   Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Erica Patterson
1   Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Karim Jessa
2   Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
3   Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Adam Paul Yan
1   Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
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Funding None.
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Abstract

Background

Many children with cancer are treated as part of interventional clinical trials. Ensuring that the correct chemotherapy treatment plan is used is paramount.

Objectives

The objectives of this report were to: (1) highlight the initial design of a clinical decision support (CDS) tool that was intended to help ensure the correct matching of research studies to research chemotherapy medications, (2) discuss the issues identified with the CDS tool, and (3) review the redesign of the tool that was done to overcome the issues identified.

Methods

We previously utilized an interruptive alert developed by Epic Systems to identify mismatches between a patient's chemotherapy plan and research study. We identified an issue with the logic of the alert resulting in the alert firing inappropriately.

Results

We estimate that the chemotherapy-research plan alert fired when 93.4% of treatment plans were applied (17.3 alerts/provider/year). A high number of misfiring alerts were identified due to the inclusion of our institution name as both (1) a “tag” in the research protocol, and (2) an unallowed tag in the research study record. Since the tag was included in all protocols, but also unallowed in all research records the alert fired with the application of almost all treatment plans. We developed a new mechanism to provide CDS that did not involve an interruptive alert. Within the research study record, we manually associate compatible treatment plans to that study record, and then when an oncologist goes to order chemotherapy the system prioritizes the display of compatible treatment plans to the oncologist. The goal of the redesigned CDS approach is to eliminate interruptive alerts while ensuring the correct chemotherapy plan is selected.

Conclusion

With end-user engagement and creative approaches to CDS design, interruptive alerts can be transitioned into passive and effective CDS tools.

Keywords

pediatrics - chemotherapy - clinical decision support - oncology - clinical trial

Protection of Human and Animal Subjects

No human subjects were involved in the project.




Publication History

Received: 08 January 2025

Accepted: 10 March 2025

Accepted Manuscript online:
12 March 2025

Article published online:
25 June 2025

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