Development and dissemination of clinical decision support across institutions: standardization and sharing of refugee health screening modules. (2nd August 2019)

• Record Type: Journal Article
• Authors: Orenstein, Evan W; Yun, Katherine; Warden, Clara; Westerhaus, Michael J; Mirth, Morgan G; Karavite, Dean; Mamo, Blain; Sundar, Kavya; Michel, Jeremy J
• Is Part Of: Journal of the American Medical Informatics Association. Volume 26:Number 12(2019)
• Page Start: 1515
• Page End: 1524
• Publication Date: 2019-08-02
• Subjects: electronic health records -- refugees -- clinical decision support -- health information interoperability, workflow analysis; Medical informatics -- Periodicals; Information Services -- Periodicals; Medical Informatics -- Periodicals; Médecine -- Informatique -- Périodiques; Informatica; Geneeskunde; Informatique médicale; Computer network resources; Electronic journals; 610.285
• DOI: 10.1093/jamia/ocz124
• Languages: English
• ISSNs: 1067-5027

Abstract

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.