Appl Clin Inform 2014; 05(04): 988-1004
DOI: 10.4338/ACI-2014-08-RA-0060
Research Article
Schattauer GmbH

Assessment of Readiness for Clinical Decision Support to Aid Laboratory Monitoring of Immunosuppressive Care at U.S. Liver Transplant Centers

J. Jacobs
1  Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
,
C. Weir
1  Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
,
R. S. Evans
1  Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
2  Medical Informatics, Intermountain Healthcare, Salt Lake City, Utah, USA
,
C. Staes
1  Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
› Author Affiliations
Further Information

Correspondence to:

Jason Jacobs
Department of Biomedical Informatics, University of Utah
421 Wakara Way, Suite 140
Salt Lake City, UT 84108
Phone: (801) 581–4080

Publication History

received: 10 August 2014

accepted: 26 November 2014

Publication Date:
19 December 2017 (online)

 

Summary

Background: Following liver transplantation, patients require lifelong immunosuppressive care and monitoring. Computerized clinical decision support (CDS) has been shown to improve post-transplant immunosuppressive care processes and outcomes. The readiness of transplant information systems to implement computerized CDS to support post-transplant care is unknown.

Objectives: a) Describe the current clinical information system functionality and manual and automated processes for laboratory monitoring of immunosuppressive care, b) describe the use of guidelines that may be used to produce computable logic and the use of computerized alerts to support guideline adherence, and c) explore barriers to implementation of CDS in U.S. liver transplant centers.

Methods: We developed a web-based survey using cognitive interviewing techniques. We surveyed 119 U.S. transplant programs that performed at least five liver transplantations per year during 2010–2012. Responses were summarized using descriptive analyses; barriers were identified using qualitative methods.

Results: Respondents from 80 programs (67% response rate) completed the survey. While 98% of programs reported having an electronic health record (EHR), all programs used paper-based manual processes to receive or track immunosuppressive laboratory results. Most programs (85%) reported that 30% or more of their patients used external laboratories for routine testing. Few programs (19%) received most external laboratory results as discrete data via electronic interfaces while most (80%) manually entered laboratory results into the EHR; less than half (42%) could integrate internal and external laboratory results. Nearly all programs had guidelines regarding pre-specified target ranges (92%) or testing schedules (97%) for managing immunosuppressive care. Few programs used computerized alerting to notify transplant coordinators of out-of-range (27%) or overdue laboratory results (20%).

Conclusions: Use of EHRs is common, yet all liver transplant programs were largely dependent on manual paper-based processes to monitor immunosuppression for post-liver transplant patients. Similar immunosuppression guidelines provide opportunities for sharing CDS once integrated laboratory data are available.

Citation: Jacobs J, Weir C, Evans RS, Staes C. Assessment of readiness for clinical decision support to aid laboratory monitoring of immunosuppressive care at U.S. liver transplant centers. Appl Clin Inf 2014; 5: 988–1004

http://dx.doi.org/10.4338/ACI-2014-08-RA-0060


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Conflict of Interest

The authors declare that they have no conflicts of interest in the research.


Correspondence to:

Jason Jacobs
Department of Biomedical Informatics, University of Utah
421 Wakara Way, Suite 140
Salt Lake City, UT 84108
Phone: (801) 581–4080