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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...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101685/ https://www.ncbi.nlm.nih.gov/pubmed/37063409 http://dx.doi.org/10.1093/jamiaopen/ooad022 |
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author | Feldstein, David A Barata, Isabel McGinn, Thomas Heineman, Emily Ross, Joshua Kaplan, Dana Bullaro, Francesca Khan, Sundas Kuehnel, Nicholas Berger, Rachel P |
author_facet | Feldstein, David A Barata, Isabel McGinn, Thomas Heineman, Emily Ross, Joshua Kaplan, Dana Bullaro, Francesca Khan, Sundas Kuehnel, Nicholas Berger, Rachel P |
author_sort | Feldstein, David A |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10101685 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-101016852023-04-14 Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice Feldstein, David A Barata, Isabel McGinn, Thomas Heineman, Emily Ross, Joshua Kaplan, Dana Bullaro, Francesca Khan, Sundas Kuehnel, Nicholas Berger, Rachel P JAMIA Open Research and Applications 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. Oxford University Press 2023-04-13 /pmc/articles/PMC10101685/ /pubmed/37063409 http://dx.doi.org/10.1093/jamiaopen/ooad022 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research and Applications Feldstein, David A Barata, Isabel McGinn, Thomas Heineman, Emily Ross, Joshua Kaplan, Dana Bullaro, Francesca Khan, Sundas Kuehnel, Nicholas Berger, Rachel P Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice |
title | Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice |
title_full | Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice |
title_fullStr | Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice |
title_full_unstemmed | Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice |
title_short | Disseminating child abuse clinical decision support among commercial electronic health records: Effects on clinical practice |
title_sort | disseminating child abuse clinical decision support among commercial electronic health records: effects on clinical practice |
topic | Research and Applications |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101685/ https://www.ncbi.nlm.nih.gov/pubmed/37063409 http://dx.doi.org/10.1093/jamiaopen/ooad022 |
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