Journal of the American Medical Informatics Association : JAMIA
Volume 26, Issue 12, 2019, Pages 1515-1524

Development and dissemination of clinical decision support across institutions: standardization and sharing of refugee health screening modules (Article)

Orenstein E.W. , Yun K. , Warden C. , Westerhaus M.J. , Mirth M.G. , Karavite D. , Mamo B. , Sundar K. , Michel J.J.
  • a Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States, Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
  • b PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
  • c PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States
  • d Department of Medicine, HealthPartners Center for International Health, Minneapolis, MN, United States
  • e PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States, Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
  • f Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
  • g Minnesota Department of Public Health, Minneapolis, MN, United States
  • h PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States
  • i Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Abstract

OBJECTIVES: We developed and piloted a process for sharing guideline-based clinical decision support (CDS) across institutions, using health screening of newly arrived refugees as a case example. MATERIALS AND METHODS: We developed CDS to support care of newly arrived refugees through a systematic process including a needs assessment, a 2-phase cognitive task analysis, structured preimplementation testing, local implementation, and staged dissemination. We sought consensus from prospective users on CDS scope, applicable content, basic supported workflows, and final structure. We documented processes and developed sharable artifacts from each phase of development. We publically shared CDS artifacts through online dissemination platforms. We collected feedback and implementation data from implementation sites. RESULTS: Responses from 19 organizations demonstrated a need for improved CDS for newly arrived refugee patients. A guided multicenter workflow analysis identified 2 main workflows used by organizations that would need to be supported by shared CDS. We developed CDS through an iterative design process, which was successfully disseminated to other sites using online dissemination repositories. Implementation sites had a small-to-modest analyst time commitment but reported a good match between CDS and workflow. CONCLUSION: Sharing of CDS requires overcoming technical and workflow barriers. We used a guided multicenter workflow analysis and online dissemination repositories to create flexible CDS that has been adapted at 3 sites. Organizations looking to develop sharable CDS should consider evaluating the workflows of multiple institutions and collecting feedback on scope, design, and content in order to make a more generalizable product. © The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: [email protected].

Author Keywords

electronic health records Refugees health information interoperability, workflow analysis clinical decision support

Index Keywords

Needs Assessment consensus decision support system workflow data interoperability artifact refugee organization multicenter study mass screening electronic health record standardization Article practice guideline human adult
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85075090502&doi=10.1093%2fjamia%2focz124&partnerID=40&md5=7ba598746d2ea7cae8271ed87474edfa
DOI: 10.1093/jamia/ocz124
ISSN: 1527974X
Original Language: English