Clinical Decision Support in the Pediatric Hospital Setting

Abstract

The electronic health record (EHR) is a key component in the delivery of healthcare in most hospitals in the USA today. Current EHR systems have evolved from simple databases for basic administrative and patient information to complex systems that are also capable of storing clinical documentation, laboratory results, and radiologic images, as well as transmitting patient care orders throughout a hospital's various departments and systems. Within the EHR, clinical decision support (CDS) tools have the potential to help improve patient care by standardizing practice, reducing errors, and aiding diagnostic and therapeutic decision-making. In the pediatric hospital setting, CDS tools can deliver pediatricspecific information and guidance on disease management through alerts, computerized provider order entry and order sets, and clinical practice guidelines. These various CDS functions are of great importance to the practice of safe, high-quality patient care and learning to maximize their potential is of great benefit to clinicians. At the same time, these tools must be implemented in a manner consistent with established CDS best practices to prevent potential unintended consequences that introduce new sources of error and potential harm.

The Use of Digital Technologies to Support Vaccination Programmes in Europe: State of the Art and Best Practices from Experts’ Interviews

“…In some regions of Italy, for example, in Lombardy, citizens can activate their EHR, called Fascicolo Sanitario Elettronico, on a voluntary basis and choose who can access their information among healthcare workers on the national territory [ 41 ]. These records can include citizens’ vaccination status [ 41 , 42 ]; in addition, an Immunisation Information System (IIS), called Anagrafe vaccinale nazionale, based on the national lifetime immunisation schedule [ 43 ], has been operational since 2018 [ 44 ]. It is monitored by the regional health authorities and used to evaluate national immunisation coverage and the performance of immunisation campaigns [ 45 ].…”

“…In particular, this app contains the list of the various vaccines indicated by the Portuguese National Immunisation Plan for each age group, as well as the recommended doses. Moreover, this app acknowledges users to record the intake of vaccines and be notified whenever a dose date is approaching [ 42 ]. The eRedbook is operational in the UK, a virtual version of the Redbook, a booklet that holds children’s growth charts and health records [ 47 ].…”

Accelerating Initiation of Adequate Antimicrobial Therapy Using Real-Time Decision Support and Microarray Testing

“…27 Clinical decision support, if implemented correctly, can offer great benefits to front-line clinicians. 28 Systems that can contact appropriate providers in “real-time”, as soon as 5-minutes after a result is posted in the EMR, may offer benefits for conditions like BSI that are time sensitive. In addition, while pop-up reminders that occur in the EMR require a provider to be logged into the system, a clinical decision support system with an ability to directly communicate with providers can further reduce any delays.…”

Clinical Decision Support in the PICU: Implications for Design and Evaluation*

“…W idespread adoption of electronic health records (EHRs) has led to substantial growth in the volume of information available to clinicians (1). Clinical decision support (CDS) systems are intended to modify the behavior of physicians and other healthcare providers through data integration and workflow processes (2). This may include active (e.g., alerts notifying providers of drug interactions) or passive (e.g., highlighted abnormal laboratory results) tools.…”