Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma
Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma
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DOI：
10.1016/j.ijmedinf.2015.12.002
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发表时间：
2016-03-01
影响因子：
4.9
通讯作者：
Dayan, Peter S.
中科院分区：
文献类型：
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作者：
Goldberg, Howard S.;Paterno, Marilyn D.;Dayan, Peter S.
目的：评估多中心临床试验中使用的远程临床决策支持（CDS）服务的架构、集成要求和执行特征。该试验测试了实施脑损伤预测规则的儿童轻微钝头traum.Materials和方法的有效性：我们集成了史诗电子健康记录（EHR）与企业临床规则服务（ECRS），基于网络的CDS服务，在两个急诊科。CDS审查模式包括延迟、近实时审查（医生查看护理评估生成的CDS建议）或实时审查（医生查看自己的文档生成的建议）。当EHR中没有来自Web服务的建议时，基于供应商的CDS以零延迟触发。我们评估了集成系统的执行特性和生成的建议由physics.Results查看的来源：ECRS平均执行时间为0.74 +/- 0.72 s。两个站点的总执行时间有很大不同，平均总事务时间分别为19.67和3.99秒。1930分析交易从这两个网站，60%（310/521）的所有医生文档发起的建议和99%（1390/1409）的所有护士文档发起的建议起源于远程web service.Discussion：远程CDS系统的来源，建议在超过一半的实时情况下，几乎所有的近实时情况。比较是有限的，允许的变化，用户的工作流程和分辨率的EHR clock.Conclusion：随着成熟和采用标准的CDS服务，远程CDS显示的承诺，以减少时间到审判的多中心评价候选人的决策支持干预措施。(C)2015爱思唯尔爱尔兰有限公司版权所有。
Objective: To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma.Materials and Methods: We integrated the Epic electronic health record (EHR) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments. Patterns of CDS review included either a delayed, near-real-time review, where the physician viewed CDS recommendations generated by the nursing assessment, or a real-time review, where the physician viewed recommendations generated by their own documentation. A backstopping, vendor-based CDS triggered with zero delay when no recommendation was available in the EHR from the web-service. We assessed the execution characteristics of the integrated system and the source of the generated recommendations viewed by physicians.Results: The ECRS mean execution time was 0.74 +/- 0.72 s. Overall execution time was substantially different at the two sites, with mean total transaction times of 19.67 and 3.99 s. Of 1930 analyzed transactions from the two sites, 60% (310/521) of all physician documentation-initiated recommendations and 99% (1390/1409) of all nurse documentation-initiated recommendations originated from the remote web service.Discussion: The remote CDS system was the source of recommendations in more than half of the real-time cases and virtually all the near-real-time cases. Comparisons are limited by allowable variation in user workflow and resolution of the EHR clock.Conclusion: With maturation and adoption of standards for CDS services, remote CDS shows promise to decrease time-to-trial for multicenter evaluations of candidate decision support interventions. (C) 2015 Elsevier Ireland Ltd. All rights reserved.