Integration of physical abuse clinical decision support into the electronic health record at a Tertiary Care Children’s Hospital

Suresh, Srinivasan; Saladino, Richard A.; Fromkin, Janet; Heineman, Emily; McGinn, Tom; Richichi, Rudolph; Berger, Rachel P.

doi:10.1093/jamia/ocy025

Cited by 35 publications

(24 citation statements)

References 26 publications

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“…This was achieved by the clinical decision‐support system synthesising the disease codes, medical tests ordered and clinician type, and applying an algorithm to trigger the alert when criteria were met. Within the second trial of the system, the researchers wanted to understand if an alert system attached to a patient eMR could cue clinicians receiving the alert to consult endorsed clinical guidelines on the evaluation of child abuse (Berger et al ., 2018; Suresh et al ., 2018). Each system is described in greater detail in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Clinical Decision Support Child Physical Abuse eMR‐based Alert – Clinical Trial 1 (2014–15) and 2 (2015) (Berger et al ., 2018; Suresh et al ., 2018)…”

Section: Resultsmentioning

confidence: 99%

“…The two trials using the same system, while having a different focus in each trial, demonstrate that eMR child protection alert systems can be successfully implemented and used by clinicians in the assessment and treatment of child physical abuse (Suresh et al ., 2018).…”

Section: Resultsmentioning

confidence: 99%

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Review of the Literature on Child Protection and Domestic Violence Electronic Medical Record Alerts

et al. 2021

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The aim of this systematic literature review was to identify peer‐reviewed publications on the use and/or evaluation of child protection or domestic violence alerts in electronic medical records. A systematic literature search yielded 751 results, with four articles retained for review. Two articles related to the Child Protection – Information Sharing electronic medical record alert system in England and two articles described a clinical decision‐support alert operating in the background of an electronic medical record system in the emergency department of the Pittsburgh Children's Hospital, Pennsylvania, USA. No articles were identified that described domestic violence electronic medical record alert systems. Child protection electronic medical record alert systems are operating in healthcare facilities in several countries. However, despite their promise in terms of improving healthcare and service coordination for children and their families, research testing the efficacy of these systems is limited. ‘Identif[ies] peer‐reviewed publications on the use and/or evaluation of child protection or domestic violence alerts in electronic medical records’ Key Practitioner Messages Child protection alerts in electronic medical records are used in a number of countries. No published examples of the use of domestic violence alerts in electronic medical records could be found. Alerts on linked electronic medical records can convey standardised, current, clinically significant information to a multitude of clinicians across several health services at once. Two evaluation studies of a child protection electronic medical record alert system were found; therefore, more evaluation studies are required.

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Section: Resultsmentioning

confidence: 99%

“…Clinical Decision Support Child Physical Abuse eMR‐based Alert – Clinical Trial 1 (2014–15) and 2 (2015) (Berger et al ., 2018; Suresh et al ., 2018)…”

Section: Resultsmentioning

confidence: 99%

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Review of the Literature on Child Protection and Domestic Violence Electronic Medical Record Alerts

et al. 2021

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“…On a service level, coded indicators of co-occurring family violence have the potential to be incorporated into computerised clinical decision support systems or risk prediction models to flag potential at-risk individuals. 132 In the UK, linkage of family members EHRs could also allow for a ‘Think-Family’ approach, where indicators have the potential to identify vulnerable children through mothers or vice versa. 133 Despite these potential implications, it remains unknown whether the benefits of using automated EHR systems to identify at-risk individuals outweigh potential harms including stigma, legal consequences, trust and reduced help-seeking.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis

et al. 2020

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ObjectiveElectronic health records (EHRs) are routinely used to identify family violence, yet reliable evidence of their validity remains limited. We conducted a systematic review and meta-analysis to evaluate the positive predictive values (PPVs) of coded indicators in EHRs for identifying intimate partner violence (IPV) and child maltreatment (CM), including prenatal neglect.MethodsWe searched 18 electronic databases between January 1980 and May 2020 for studies comparing any coded indicator of IPV or CM including prenatal neglect defined as neonatal abstinence syndrome (NAS) or fetal alcohol syndrome (FAS), against an independent reference standard. We pooled PPVs for each indicator using random effects meta-analyses.ResultsWe included 88 studies (3 875 183 individuals) involving 15 indicators for identifying CM in the prenatal period and childhood (0–18 years) and five indicators for IPV among women of reproductive age (12–50 years). Based on the International Classification of Disease system, the pooled PPV was over 80% for NAS (16 studies) but lower for FAS (<40%; seven studies). For young children, primary diagnoses of CM, specific injury presentations (eg, rib fractures and retinal haemorrhages) and assaults showed a high PPV for CM (pooled PPVs: 55.9%–87.8%). Indicators of IPV in women had a high PPV, with primary diagnoses correctly identifying IPV in >85% of cases.ConclusionsCoded indicators in EHRs have a high likelihood of correctly classifying types of CM and IPV across the life course, providing a useful tool for assessment, support and monitoring of high-risk groups in health services and research.

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“…The automated alert can be coupled with visualisation of clinical and radiological indicators that will enable the healthcare providers to quickly review the critical risk factors. There have been some successful attempts to develop a multifaceted child abuse clinical decision support system comprised of a trigger system, alerts and a physical abuse order set, resulting in increase in the number of young children identified as having injuries suspicious for physical abuse in general emergency departments 16–19…”

Section: Integration Of Aimentioning

confidence: 99%

Making the ‘invisible’ visible: transforming the detection of intimate partner violence

et al. 2019

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Integration of physical abuse clinical decision support into the electronic health record at a Tertiary Care Children’s Hospital

Cited by 35 publications

References 26 publications

Review of the Literature on Child Protection and Domestic Violence Electronic Medical Record Alerts

Review of the Literature on Child Protection and Domestic Violence Electronic Medical Record Alerts

Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis

Making the ‘invisible’ visible: transforming the detection of intimate partner violence

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