P60– Decision support capabilities of commercial

EHRS and implications for guideline developers

Adam Wright, PhD (Presenter) (Brigham andWomen’s Hospital, Boston, Massachusetts);Justine E. Pang (Brigham and Women’s Hospital,Boston, Massachusetts); Sapna Sharma (OHSU,Portland, Oregon); Dean F. Sittig, PhD (UT Houston,Houston, Texas); Blackford Middleton, MD (PartnersHealthCare, Wellesley, Massachusetts)

PRIMARY TRACK: Guideline implementationSECONDARY TRACK: Computer-based decision supportBACKGROUND (INTRODUCTION): Guidelines are of-ten implemented as clinical decision support (CDS) in com-mercial electronic health record systems. However, the CDScapabilities of commercial EHR systems differ widely, andthese differences have important implications for guidelinedevelopers.LEARNING OBJECTIVES (TRAINING GOALS):

1. Identify clinical decision support features of electronichealth record systems.

2. Understand differences in the CDS features of variouscommercial EHR systems.

3. Understand the implications of these differences forguideline development.

METHODS: We compared the capabilities of nine commer-cially available clinical information systems against the 42functional taxa from a published taxonomy of CDS capabili-ties. The taxonomy has four axes: 1) Triggers: events thatcause a decision support rule to be invoked (e.g., ordering alaboratory test); 2) Input data: data used by a rule to makeinferences (e.g., the patient’s problem list); 3) Interventions:possible actions a decision support module can take (e.g.,showing a guideline); 4) Offered choices: many decision sup-port events require users of a clinical system to make a choice,e.g., choosing a safer drug.RESULTS: Overall, there was a great deal of variabilityamong capabilities of the systems possessed. The two weakestsystems evaluated were missing 18 of 42 capabilities, while thestrongest system was missing only a single capability. Four ofnine unique triggers (order entered, outpatient encounteropened, user request, and time) were available in all systems,seven of 14 input data elements were universally available, twoof seven interventions (notify and show data entry template)were available in all systems, and only three of 12 offeredchoices were available in all nine systems.DISCUSSION (CONCLUSION): The clinical decisionsupport (CDS) capabilities of these CCHIT-certified EHRswere variable, and none of the systems had every capability.Guideline authors and implementers should design guidelineswith knowledge of the varying capabilities of EHRs and,preferably, guidelines should degrade gracefully in the absenceof certain CDS capabilities or EHR data.TARGET AUDIENCE(S):

1. Guideline developer2. Guideline implementer

3. Developer of guideline-based products4. Health care policy analyst/policy-maker

P61– Delphi consensus on the feasibility of

translating the American College of Emergency

Physicians clinical policies into computerized

clinical decision support

Edward R. Melnick, MD (Presenter) (North ShoreUniversity Hospital, Long Island City, New York);Jeffrey A. Nielson, MD (Akron City Hospital, Akron,Ohio); John T. Finnell, MD (Indiana UniversitySchool of Medicine, Indianapolis, Indiana);Saumil J. Patel, BS (North Shore UniversityHospital, Manhasset, New York);Lynne D. Richardson, MD (Mount Sinai School ofMedicine, New York, New York)

PRIMARY TRACK: Guideline implementationSECONDARY TRACK: Computer-based decision supportBACKGROUND (INTRODUCTION): The American Col-lege of Emergency Physicians (ACEP) Clinical Policies havebeen shown to be safe and effective. However, these evidence-based practice guidelines face barriers to effective implemen-tation. Translation of the ACEP Clinical Policies into comput-erized Clinical Decision Support (CDS) could help addressthese barriers and improve clinician decision-making at thepoint of care.LEARNING OBJECTIVES (TRAINING GOALS):

1. Assess the feasibility of translating the ACEP ClinicalPolicies into CDS.

2. Improve future ACEP guideline development with thegoal of implementation into CDS.

METHODS: The investigators convened an informatics ex-pert panel of 14 emergency physicians chosen for their exper-tise in CDS. The recommendation sections from the six mostrecent ACEP Clinical Policies were distributed to the panel forreview. Four rounds of the Delphi consensus process wereperformed using SurveyMonkey, a web-based survey tool.With the goal of working toward consensus, anonymous re-sponses from the prior round of the Delphi process wereprovided for the panelists’ consideration.RESULTS: The panel members had a 100% completionrate for all four rounds of the Delphi process. All 14members of the panel signed the resulting consensusdocument. The panel identified four limitations to trans-lation, including: guidelines that are too vague, are notcomprehensive enough, require additional physician in-put or knowledge for translation, and when translatedwould impede clinical workflow due to excessive dataentry. The panel made the following recommendationsfor future guideline development and implementationwith the goal of implementation into CDS: provide ac-tionable recommendations, include informatics specialistinput throughout guideline development, and CDS shouldbe deployed using a modular approach to allow for futureflexibility and customization.

109Poster