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.
