Best Paper Selection

Appendix: Content Summaries of Selected Best Papers for the 2024 IMIA Yearbook, Section Decision Support

Co Z, Classen DC, Cole JM, Seger DL, Madsen R, Davis T, McGaffigan P, Bates DW.

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool.

Appl Clin Inform. 2023 Oct;14(5):981-991.

doi: 10.1055/s-0043-1777107

This cross-sectional study evaluated the medication-related decision support capabilities of outpatient electronic health record (EHR) systems using the Ambulatory EHR Evaluation Tool. Ten outpatient clinics participated in the study. The results showed that clinics performed well in basic decision support features such as drug allergy checks but struggled in areas of advanced decision support such as drug age, drug laboratory, and drug monitoring. Only one clinic was able to electronically reconcile medication lists, while the others performed manual reconciliation without triggering any decision support. Most clinics used interruptive and non-interruptive alerts, but customization options for alerts and associated medication reference databases were limited. Overall, the study identified CDS opportunities for improvement in outpatient medication safety.

Martin B, Mulhern B, Majors M, Rolison E, McCombs T, Smith G, Fisher C, Diaz E, Downen D, Brittan M.

Improving Pediatric Intensive Care Unit Discharge Timeliness of Infants with Bronchiolitis Using Clinical Decision Support.

Appl Clin Inform. 2023 Mar;14(2):392-399.

doi: 10.1055/a-2036-0337

This work was aimed at improving the timeliness of transferring infants with bronchiolitis from the pediatric intensive care unit (PICU) to the general ward using an alert-based clinical decision support (CDS) system. The study was motivated by a prior quality improvement initiative that demonstrated the need for automating the process of tracking of respiratory support to help identify transfer-ready candidates. The CDS system sends an alert to clinicians to assess transfer readiness once a child has been on floor-appropriate respiratory support for at least six hours. The study compared time-to-transfer, PICU length of stay, and hospital length between patients admitted before and after CDS implementation. The results showed that patients in the post-implementation phase had a shorter median time-to-transfer compared to those in the pre-implementation phase.

Wilson FP, Yamamoto Y, Martin M, Coronel-Moreno C, Li F, Cheng C, Aklilu A, Ghazi L, Greenberg JH, Latham S, Melchinger H, Mansour SG, Moledina DG, Parikh CR, Partridge C, Testani JM, Ugwuowo U.

A randomized clinical trial assessing the effect of automated medication-targeted alerts on acute kidney injury outcomes.

Nat Commun. 2023 May 17;14(1):2826.

doi: 10.1038/s41467-023-38532-3

The objective of this multi-center randomized clinical trial was to assess the effect of alerting discontinuation of kidney function related medications – non-steroidal anti-inflammatory drugs (NSAIDs), renin-angiotensin-aldosterone system inhibitors (RAASi), and proton pump inhibitors (PPIs) – on acute kidney injury (AKI) outcomes. The primary outcome was a composite of AKI progression, dialysis, or death within 14 days of randomization or hospital discharge. The results indicated that alerts led to a reduction in the primary outcome, particularly in the PPI subgroup. A mediation analysis with discontinuation of medications of interest as a mediator showed that there may be some clinical benefit driven by cessation of PPIs.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
08 April 2025