David A Feldstein, Isabel Barata, Thomas McGinn, Emily Heineman, Joshua Ross, Dana Kaplan, Francesca Bullaro, Sundas Khan, Nicholas Kuehnel, Rachel P Berger
{"title":"在商业电子健康记录中传播虐待儿童临床决策支持:对临床实践的影响。","authors":"David A Feldstein, Isabel Barata, Thomas McGinn, Emily Heineman, Joshua Ross, Dana Kaplan, Francesca Bullaro, Sundas Khan, Nicholas Kuehnel, Rachel P Berger","doi":"10.1093/jamiaopen/ooad022","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The use of electronic health record (EHR)-embedded child abuse clinical decision support (CA-CDS) may help decrease morbidity from child maltreatment. We previously reported on the development of CA-CDS in Epic and Allscripts. The objective of this study was to implement CA-CDS into Epic and Allscripts and determine its effects on identification, evaluation, and reporting of suspected child maltreatment.</p><p><strong>Materials and methods: </strong>After a preimplementation period, CA-CDS was implemented at University of Wisconsin (Epic) and Northwell Health (Allscripts). Providers were surveyed before the go-live and 4 months later. Outcomes included the proportion of children who triggered the CA-CDS system, had a positive Child Abuse Screen (CAS) and/or were reported to Child Protective Services (CPS).</p><p><strong>Results: </strong>At University of Wisconsin (UW), 3.5% of children in the implementation period triggered the system. The CAS was positive in 1.8% of children. The proportion of children reported to CPS increased from 0.6% to 0.9%. There was rapid uptake of the abuse order set.At Northwell Health (NW), 1.9% of children in the implementation period triggered the system. The CAS was positive in 1% of children. The child abuse order set was rarely used. Preimplementation, providers at both sites were similar in desire to have CA-CDS system and perception of CDS in general. After implementation, UW providers had a positive perception of the CA-CDS system, while NW providers had a negative perception.</p><p><strong>Discussion: </strong>CA-CDS was able to be implemented in 2 different EHRs with differing effects on clinical care and provider feedback. At UW, the site with higher uptake of the CA-CDS system, the proportion of children who triggered the system and the rate of positive CAS was similar to previous studies and there was an increase in the proportion of cases of suspected abuse identified as measured by reports to CPS. Our data demonstrate how local environment, end-users' opinions, and limitations in the EHR platform can impact the success of implementation.</p><p><strong>Conclusions: </strong>When disseminating CA-CDS into different hospital systems and different EHRs, it is critical to recognize how limitations in the functionality of the EHR can impact the success of implementation. 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There was rapid uptake of the abuse order set.At Northwell Health (NW), 1.9% of children in the implementation period triggered the system. The CAS was positive in 1% of children. The child abuse order set was rarely used. Preimplementation, providers at both sites were similar in desire to have CA-CDS system and perception of CDS in general. After implementation, UW providers had a positive perception of the CA-CDS system, while NW providers had a negative perception.</p><p><strong>Discussion: </strong>CA-CDS was able to be implemented in 2 different EHRs with differing effects on clinical care and provider feedback. At UW, the site with higher uptake of the CA-CDS system, the proportion of children who triggered the system and the rate of positive CAS was similar to previous studies and there was an increase in the proportion of cases of suspected abuse identified as measured by reports to CPS. 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引用次数: 2
摘要
目的:使用电子健康记录(EHR)嵌入儿童虐待临床决策支持(CA-CDS)可能有助于减少儿童虐待的发病率。我们之前报道了Epic和Allscripts中ca - cd的开发。本研究的目的是在Epic和Allscripts中实施CA-CDS,并确定其对疑似儿童虐待的识别、评估和报告的影响。材料和方法:在预实施期后,CA-CDS在威斯康星大学(Epic)和Northwell Health (Allscripts)实施。在上线前和4个月后分别对供应商进行了调查。结果包括触发CA-CDS系统的儿童比例,具有积极的儿童虐待筛查(CAS)和/或报告给儿童保护服务(CPS)。结果:在威斯康星大学(UW), 3.5%的儿童在实施期间触发了该系统。1.8%的儿童CAS呈阳性。接受CPS治疗的儿童比例从0.6%上升到0.9%。人们很快就接受了虐待令。在Northwell Health (NW),实施期间有1.9%的儿童触发了该系统。1%的儿童CAS呈阳性。虐待儿童令很少被使用。在实施前,两个地点的提供者对CA-CDS系统的愿望和对CDS的总体看法是相似的。实施后,威斯康星大学的提供者对CA-CDS系统有积极的看法,而西北大学的提供者有消极的看法。讨论:CA-CDS能够在两种不同的电子病历中实施,对临床护理和提供者反馈有不同的影响。在华盛顿大学,CA-CDS系统使用率较高的地方,触发该系统的儿童比例和CAS阳性率与以前的研究相似,并且根据向CPS报告的数据,发现疑似虐待案件的比例有所增加。我们的数据表明,本地环境、最终用户的意见和EHR平台的局限性如何影响实施的成功。结论:当将CA-CDS推广到不同的医院系统和不同的电子病历时,认识到电子病历功能的局限性如何影响实施的成功是至关重要的。收集、解释和回应提供者反馈的重要性是至关重要的,特别是与儿童虐待有关的CDS。
Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice.
Objectives: The use of electronic health record (EHR)-embedded child abuse clinical decision support (CA-CDS) may help decrease morbidity from child maltreatment. We previously reported on the development of CA-CDS in Epic and Allscripts. The objective of this study was to implement CA-CDS into Epic and Allscripts and determine its effects on identification, evaluation, and reporting of suspected child maltreatment.
Materials and methods: After a preimplementation period, CA-CDS was implemented at University of Wisconsin (Epic) and Northwell Health (Allscripts). Providers were surveyed before the go-live and 4 months later. Outcomes included the proportion of children who triggered the CA-CDS system, had a positive Child Abuse Screen (CAS) and/or were reported to Child Protective Services (CPS).
Results: At University of Wisconsin (UW), 3.5% of children in the implementation period triggered the system. The CAS was positive in 1.8% of children. The proportion of children reported to CPS increased from 0.6% to 0.9%. There was rapid uptake of the abuse order set.At Northwell Health (NW), 1.9% of children in the implementation period triggered the system. The CAS was positive in 1% of children. The child abuse order set was rarely used. Preimplementation, providers at both sites were similar in desire to have CA-CDS system and perception of CDS in general. After implementation, UW providers had a positive perception of the CA-CDS system, while NW providers had a negative perception.
Discussion: CA-CDS was able to be implemented in 2 different EHRs with differing effects on clinical care and provider feedback. At UW, the site with higher uptake of the CA-CDS system, the proportion of children who triggered the system and the rate of positive CAS was similar to previous studies and there was an increase in the proportion of cases of suspected abuse identified as measured by reports to CPS. Our data demonstrate how local environment, end-users' opinions, and limitations in the EHR platform can impact the success of implementation.
Conclusions: When disseminating CA-CDS into different hospital systems and different EHRs, it is critical to recognize how limitations in the functionality of the EHR can impact the success of implementation. The importance of collecting, interpreting, and responding to provider feedback is of critical importance particularly with CDS related to child maltreatment.