An integrated web application for decision support and automation of EHR workflow: a case study of current challenges to standards-based messaging and scalability from the EMBED trial. Issue 4 (14th October 2019)

• Record Type: Journal Article
• Authors: Melnick, Edward R; Holland, Wesley C; Ahmed, Osama M; Ma, Anthony K; Michael, Sean S; Goldberg, Howard S; Lagier, Christian; D'Onofrio, Gail; Stachowiak, Tomek; Brandt, Cynthia; Solad, Yauheni
• Is Part Of: JAMIA open. Volume 2:Issue 4(2019)
• Page Start: 434
• Page End: 439
• Publication Date: 2019-10-14
• Subjects: clinical decision support systems -- emergency department-initiated buprenorphine -- buprenorphine -- user-centered design -- EHR interoperability; Medical informatics -- Periodicals; 610.285
• DOI: 10.1093/jamiaopen/ooz053
• Languages: English
• ISSNs: 2574-2531

Abstract

Abstract: Computerized clinical decision support (CDS) faces challenges to interoperability and scalability. Centralized, web-based solutions offer a mechanism to share the cost of CDS development, maintenance, and implementation across practices. Data standards have emerged to facilitate interoperability and rapid integration of such third-party CDS. This case report describes the challenges to implementation and scalability of an integrated, web-based CDS intervention for EMergency department-initiated BuprenorphinE for opioid use Disorder which will soon be evaluated in a trial across 20 sites in five healthcare systems. Due to limitations of current standards, security concerns, and the need for resource-intensive local customization, barriers persist related to centralized CDS at this scale. These challenges demonstrate the need and importance for future standards to support two-way messaging (read and write) between electronic health records and web applications, thus allowing for more robust sharing across health systems and decreasing redundant, resource-intensive CDS development at individual sites.